Bill, a 51-year-old white male, was assisting in the launching of his best frien
ID: 8789 • Letter: B
Question
Bill, a 51-year-old white male, was assisting in the launching of his best friend’s water-ski boat from a faulty boat trailer when he began to experience chest discomfort. At first, he believed his discomfort was because of the extreme July heat. Gradually, the discomfort became a crushing pain in his sternal area that radiated into his left arm and lower jaw. His friend suspected an ensuing heart attack and convinced Bill to check into an emergency room. During the drive down a canyon with steep, winding curves, Bill collapsed.On arrival at the emergency room, Bill was unconscious. His skin was cool, clammy, and very pale. His blood pressure was very low and his pulse was weak and irregular. Established resuscitation procedures were followed. After Bill’s return to consciousness, an electrocardiogram showed evidence of myocardial injury and blood was drawn to check enzyme and electrolyte levels. When history was obtained, Bill stated he is a harassed advertising executive and denied significant illnesses. However, he is being treated for primary hypertension. He acknowledged smoking three packs of cigarettes a day for 30 years. His father died of a heart attack at the age of 47
Bill’s subsequent electrocardiograms and serum levels of CPK, LDH, and SGOT or AST verified anterior myocardial infarction.
Knowing the diagnosis, identify Bill's risk factors, the early causes and precipitating events of his infarction, and the justification for using anticoagulant therapy?
Explanation / Answer
The above given case suggests the diagnosis of anterior myocardial infarction (MI). It is commonly known as heart attack. This problem is occurred when the anterior myocardial tissue has suffered any injury due to low or lack of blood supply. If a coronary artery is blocked suddenly or has extremely slow blood flow, then a heart attack or myocardial infraction is caused. The coronary artery is usually blocked because of the formation of blood clot (thrombus) in it.
Risk factors for myocardial infraction are:
High cholesterol levels in the blood, high blood pressure, kidney failure, smoking, obesity, diabetes can lead to the occurrence of heart attack. Ageing and poor lifestyle practices (such as lack of exercise, unhealthy eating practices, alcohol consumption, poor diet etc.) for a long time can also lead to the development of coronary heart diseases.
Early causes of myocardial infarction can be:
Sudden blockage of the coronary artery, or very low blood supply causes heart attack. Signs and symptoms include: pressure or tightness or pain in the chest or arms which gradually spreads towards neck, jaw and back. Fatigue, shortness in the breath, cold sweat and prolonged dizziness are also the signs of MI.
Precipitating events of MI in this case are:
Physical exertions as Bill was busy in launching of his friend’s event and the climatic conditions also contribute to the occurrence of MI. He also had a family history of heart attacks (his father died in early age because of the same reason). Since Bill admitted that he has smoking been smoking from past 30 years, it also can be a precipitating factor. Presence of hypertension also has an impact on the development of MI.
A lot of research has been done to identify the effectiveness of anticoagulant therapy on anterior myocardial infarction. The presence of heparin may prevent the extension of coronary thrombosis. Preventing the progression of coronary thrombosis can reduce the risk of infarction or the size or infarct. It also clears the clot and reduces the chances of reinfarction. However, it has a risk of haemorrhage.
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