A 76-year-old man complained to his wife of severe sub-sternal chest pains that

Question

A 76-year-old man complained to his wife of severe sub-sternal chest pains that radiated down the inside of his left arm.Shortly afterward, he collapsed on the living room floor. Paramedics arriving at his house just minutes later found himunresponsive, not breathing, and without a pulse. CPR and electroconvulsive shock were required to start his heartbeating again. Upon arrival at the hospital, the man started to regain consciousness, complaining of severe shortness ofbreath (dyspnea) and continued chest pain. On physical examination, his vital signs are listed below. His breathing waslabored, his pulses were rapid and weak everywhere, and his skin was cold and clammy. An ECG was done, revealingsignificant "Q" waves in most of the leads. Blood testing revealed markedly elevated creatine phosphokinase (CPK)levels of cardiac muscle origin. Arterial blood was sampled and revealed the following:

Vital Signs:
• Systemic blood pressure: 85 mm / 50 mm Hg• Heart rate: 175 beats / minute• Respiratory rate: 32 breaths / minute• Temperature: 99.2°F

Blood test results:
• pH: 7.22• pCO2 : 30 mm Hg• pO2: 70 mm Hg• Hemoglobin - O2 saturation = 88 %• [HCO3

-] = 2 meq/liter

explain about the disease, causes, and diagnosis

Explanation / Answer

According to the sign and symptoms, and blood test result, The disease is myocardial infarction commonaly known as heart attack. Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen. Other symptoms include shortness of breath, cold sweating, and abnormal blood pressure. The mechanism of an MI often involves the complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque.

Causes: The most prominent risk factors for myocardial infarction are older age, actively smoking, high blood pressure, diabetes mellitus, and total cholesterol and high-density lipoprotein levels. Other risk factors are male sex, low levels of physical activity, a past family history, obesity, and alcohol use.

Diagnosis: A diagnosis of myocardial infarction is created by integrating the history of the presenting illness and physical examination with electrocardiogram findings and cardiac markers (blood tests for heart muscle cell damage). A coronary angiogram allows visualization of narrowings or obstructions on the heart vessels, and therapeutic measures can follow immediately. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathological findings. A chest radiograph and routine blood tests may indicate complications or precipitating causes and are often performed upon arrival to an emergency department. New regional wall motion abnormalities on an echocardiogram are also suggestive of a myocardial infarction. Echo may be performed in equivocal cases by the on-call cardiologist.

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