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) Majorly, patient's heat was unable to pump enough blood to all parts of the body due to a block present in the arteries, which is depleting the levels of blood. Due to this low blood level, the capturing of oxygen decreases. The insufficient supply of oxygen to the heart cells will lead tothe death of the cells. With the available blood, oxygen and live cells, the heart tries to work vigourously. It leads to arrhythmias and heart enlargment.

The another medical problem is the presence of carcinoid tumours, which are origniated in the gut wall and speards to other parts of the body. These tumours are diffused into liver and mesentery.

2) Ejection fraction (EF) is the measurement to determine the wellness of heart. It is calculated as Ejection fraction = Stroke volume/ End diastolic volume* 100. If the result of EF measurment is above 55%, the heart is considered as normal. If EF is blow 30%, it is bad.

3) Coronary artery bypass graft surgery is surgical procedure, in which blocked coronary arteries are bypassed by grafting blood vessles to restore normal blood flow to the heart.

4) Carotid endartarectomy is the surgical procedure to remove material on the inside of an artery to reduce the risk of stroke. There is great possible to become risk to this medicial condition. This is because of heart enlargment that took place due to virogorus working of the heart.

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