Case Study 9 Activity

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University of North Carolina, Charlotte *

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4000

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Medicine

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Apr 29, 2024

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docx

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Part I – The heart of the matter You recently graduated from Brody School of Medicine in East Carolina and have just started your first year of residency at UNC Medical Center. You and your co-residents are on a cardiology rotation. You all are in the lounge and are studying and quizzing each other on some typical cardiology terms and diagnoses. Questions 1. Match the lettered term to the correct definition listed below. A. Infarction B. Ischemia C. Hypoxia D. Cardiac Arrest E. Stroke F. Heart attack B Deficient supply of blood to a body part (such as the heart or brain) that is due to obstruction of the inflow of arterial blood. C A deficiency of oxygen reaching the tissues of the body. E When blood flow to the brain is impaired, resulting in oxygen deprivation and death of brain cells. D Temporary or permanent cessation of the heartbeat. F When blood supply to the heart muscle is severely reduced or cut off. A Injury or death of tissue (as of the heart or lungs) resulting from inadequate blood supply especially because of obstruction of the local circulation by a thrombus or embolus. 2. Using the definitions, you just learned above, let us create a sentence or small paragraph below that correctly relates and uses all the terms above (some terms have already been used and might be used more than once!). A Heart attack (e.g., myocardial infarction, acute coronary syndrome) is a kind of infarction where some form of blockage in the (coronary arteries) vessels feeding the heart causes ischemia in the heart muscle resulting in hypoxia and tissue damage. Stroke is hypoxia of the brain. While infarction, stroke , heart attack and cardiac arrest are all associated with infarction , cardiac arrest is defined by lack of blood flow due to no pumping action of the heart (an ‘electrical’ problem!) whereas stroke and myocardial infarction aree both associated with ischemia and are considered to be infarctions (a ‘circulation’ problem!) 3. What do you think happens to the heart when its blood supply is severely reduced, restricted, or entirely cut off? It can lead to tissue damage or death of heart muscle cells which can cause symptoms ranging from chest pain to cardiac arrest or even death. 4. Watch the video below on myocardial infarction and then briefly describe what disrupts cardiac blood flow during a heart attack. (Note: dyspnea is labored or difficult breathing.)

A blockage, tobacco toxins, plaques. • An Osmosis Video: Heart Attack Explained. Produced by Osmosis.org, 2018. <https://youtu.be/2kLlhlsesRQ> 5. In the video, you learned about symptoms of a heart attack. List those here. Then, use the resource below to note which three symptoms are more common in women compared to men. Chest pain and pressure, abnormal sweating, nausea, fatigue, shortness of breath, tingling or pain in left arm. Women: back and jaw pain, nausea, fatigue, shortness of breath. • American Heart Association. (n.d.). Heart attack symptoms in women [webpage]. <https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack- symptoms- in-women> 6. Formulate a hypothesis about what type of tests would be useful in detecting a heart attack. You do not need to know specific names of tests (if you do, that is fine), but list the type of information you would want to gather. List two to three possible tests or procedures. Tests that would be useful in detecting a heart attack may include electrocardiogram which is an ECG/EKG to assess heart rhythm and electrical activity. Cardiac biomarker tests like troponin and CK- MB can be used to detect heart muscle damage, and imaging tests like echocardiography or coronary angiography to visualize the hearts’ structure and blood flow. Part II – The patient The hospital is alerted that an ambulance is on the way with a patient, George Menezes, age 64, chest pains, with lightheadedness; suspected heart attack via a 12 lead ECG that was taken enroute to the hospital. The EMTs notify your team that they started an IV and collected blood samples for cardiac biomarker labs. You and your team run down to the emergency room to meet the ambulance, help transfer the patient, and get the blood samples sent to the lab. Your attending physician says that the ECG reveals myocardial infarction (MI), and the patient will immediately need to be transferred to the catheterization (cath) lab so that a coronary angiogram can be performed. While you are waiting, you pull out your handy cardiac testing sheet primer [get this from your instructor] to quiz yourself on what other tests could have been useful if an MI were not already confirmed. Questions 7. Using the primer and your answers from Question 6 in Part I, choose four tests you think would be good identifiers of an MI. In the table below, provide a brief justification for, and the predicted results from, the tests. Test Wh y Predicted result

Troponin levels Troponin is released into the bloodstream when heart muscle is damaged, which could indicate myocardial injury. Elevated troponin levels CK-MB levels CK-MB is an enzyme released into the bloodstream during heart muscle damage Elevated CK-MB levels Electrocardiogram (ECG) ECG can show characteristic changes like ST-segment elevation indicative of myocardial infarction. ST-segment elevation or other ischemic changes Coronary angiography Allow direct visualization of coronary arteries to identify blockages or occlusions Presence of blockages or stenosis 7. Draw a graph showing predicted troponin I, troponin T, and CK-MB levels in the bloodstream after a suspected myocardial infarction. For the x-axis use time and include hours 2–4, 24, and 48, as well as 7 days; for the y-axis you can list relative concentration.

Part III – Arrival Mr. Menezes has arrived at the hospital; the emergency department (ED) staff has taken him to the cath lab. You obtain the vitals, 12-lead ECG, and history from the EMTs. It is 8:55 a.m. You thank the EMTs, and rush to the cath lab, not far behind your patient. While the team preps Mr. Rodriquez for the angiogram and waits for the interventional cardiologist to arrive, you and your attending review the history the EMTs took in transit. George Menezes; 64 yrs old; male Arrived to work at 7:00 a.m. Shortly after arrival, he felt severe chest and neck pains, discomfort in his left shoulder, and became lightheaded. His employees became very worried and after some persuading, George allowed them to call 911. Vitals taken enroute are listed below. George was given oxygen in the ambulance. • Family history of cardiovascular disease • Currently not on medication; no recent phosphodiesterase inhibitor use • No surgeries in the last year • No known allergies • No history of blood clotting disorders • History of untreated pre-diabetes and hypertension • Four children • Works many hours a week as manager; job stress; often works overtime • No time to exercise • Diet includes lots of fast food and convenience items • Long-term smoker; one pack per day for 20 years Table 1 . Vitals of George Menezes; taken enroute to ED. Question Test Normal Male Value G. Menezes Blood Pressure (mmHg) 120/80 155/95 Pulse (bpm) 60–100 110, regular Oxygen Saturation (%) 95–100 89

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