Reference no: EM132896555

Diagnostic Analysis

Cardiac radio-nuclear scanning, EKG, and studies ruled out the possibility of MI. Troponins and serial cardiac enzyme indicated cardiac ischemia. Stress testing and a nucleotide scan indicated that the patient was having exercise-related myocardial ischemia (angina). Echocardiography indicated that the heart muscle at the site of ischemia was functioning poorly. Transesophageal echocardiography indicated that the patient had mitral regurgitation. Cardiac catheterization with cineventriculography demonstrated near-normal ventricular function, and coronary angiography indicated significant narrowing of the left coronary artery. Mitral regurgitation was also seen. The patient's angina was then thought to be caused by the coronary artery disease. Open heart surgery was performed. The patient's mitral valve was replaced with a prosthesis, and an aortocoronary artery bypass graft was performed. Postoperatively, he had a large pericardial effusion. This diminished his heart function. He underwent pericardiocentesis, and his function improved. Because his serum lipids study showed type IIa hyperlipidemia, a low-cholesterol diet and cholesterol-lowering agents were prescribed. The other cardiac risk factors did indicate increased risk for coronary heart disease. Six months later he was asymptomatic and jogging 3 miles per day.

Discussion 1. Based on the ratio of cholesterol to HDL, what is the patient's risk for coronary heart disease?

Discussion 2. If these blood tests were drawn 1 year ago, what treatment would have been indicated?

Discussion 3. Could surgery have been avoided?

Attachment:- HDL.zip