Myocardial Infarction
Patient Presentation:
C.L., a 65 year old male presents to the ER with complaints of chest pain. He describes it as a chest pressure radiating into left arm and jaw, and states it feels as though somebody is stepping on his chest and it is hard to breathe. He attempted to “sleep it off” with no relief. Pain is unrelieved by rest, and increases in severity with even minimal activity. Pain began approximately twelve hours ago. He has never felt this type of pain before, and has no significant prior medical history.
Differential Diagnoses:
Myocardial infarction, pulmonary embolism
Diagnosis:
With the presentation of chest pain this patient was immediately started on a telemetry monitor. An EKG was also obtained. This showed a normal sinus rhythm. Rate in the 80’s with T wave changes. Labs were also drawn at this point. CBC was unremarkable. Troponin value was 45.8 mcg/L and D-dimer was 0.7 mg/L, both elevated.
Treatment:
After seeing the results of the troponin and EKG, this patient was immediately started on a heparin IV drip and then brought to the cath lab. An angiogram was performed with subsequent angioplasty and two stents placed to the left anterior descending artery.
Outcome:
Pt returned from the cath lab and remained in the hospital for three days. Medications initiated included Plavix® 600 mg once followed by 75 mg once daily, 325 mg aspirin once daily, a beta blocker, ace inhibitor and a statin. Because of the severity of the MI, this patient’s ejection fraction was down to 35%. This patient and his family were educated on lifestyle changes and heart failure instructions. Particular reinforcement was paid to fluid restriction, cardiac diet and activity levels. This patient was also enrolled in an outpatient cardiac rehabilitation program. Follow up appointment scheduled for one week from discharge.
Case created by Carrie Loberg, 2010.