Answer the questions based on the following Medical Record: History of present I

Question

Answer the questions based on the following Medical Record:

History of present Illness: This 77 year old gentleman was hospitalized with chest pain, and a diagnosis of myocardial infarction was made. The patient had CPK elevation to 800 with 10% MB fraction. He subsequently developed heart failure and cardiac arrhythmia. He underwent cardiac catheterization and coronary angiography. His ejection fraction was 30%. He has severe left main coronary artery stenosis and right coronary artery occlusion. The patient has had carcinoid tumor of bowel resected 4-5 years ago and in a recent laparotomy he was found to have diffuse carcinoid involvement of the liver and mesentery. The patient did have small bowel resection and currently has a colostomy. He is expected to live 2-3 years.

Past Medical History: Long standing hypertension, colostomy secondary to bowel carcinoma, transurethral resection of the prostate, previous transient ischemic attacks, and bilateral carotid disease with 60-70% stenosis.

Impression:
Severe coronary artery disease with recent with recent myocardial infarction, high grade left main coronary artery stenosis and occlusion of right coronary artery, ischemic cardiomyopathy, ventricular and supraventricular arrhythmias
History of carcinomatosis, status post recent bowel obstruction, previous colostomy
Carotid occlusive disease with history of transient ischemic attacks.

Recommendation:
The patient and his family are fully aware of recent cardiac catheterization findings. The patient is in agreement with proceeding with coronary artery bypass graft surgery, knowing that he is expected to live 2-3 years. Informed consent has been obtained.

1) What medical problems does the patient have? Explain these in lay terms, as if you were talking with the patient and his family.
2) What does it mean to have a "30% ejection fraction?" Is this good or bad?
3) Describe the coronary artery bypass graft surgical procedure in lay terms.
4) What is carotid endartarectomy, and is this patient a good risk for it? Why or why not?

Explanation / Answer

1. The patient's heart is not being able to supply blood to all regions, because it is not recieving good oxygen supply may be because of block in his arteries, this is causing pain in the pain in chest region. This causes restrited blood supply to his heart, so some of the heart cells are dead. To compensate the body needs, heart tries to beat more and work more, which gave ris to arrhythmias, and heart enlargement. The patient is suffering frrom carcinoid tumours, which originate in the gut wall and (but grows slowely) and speards into other organs. Now these carcinoid tumours have diffused to liver and mesetry.

2. Ejection fraction = Stroke volume/ End diastolic volume* 100. If the ejection fraction is above 55%, it is considered as normal, ejection fraction 30% indicates low cardiac output, which is "bad."

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