Mr. W.G. is a 53-year-old white man who began to experiencechest discomfort while playing tennis with a friend. At first, heattributed his discomfort to the heat and having had a largebreakfast. Gradually, however, discomfort intensified to a crushingsensation in the sternal area and the pain seemed to spread upwardinto his neck and lower jaw. The nature of the pain did not seem tochange with deep breathing. When Mr. G. complained of feelingnauseated and began rubbing his chest, his tennis partner wasconcerned that his friend was having a heart attack and called 911on his cell phone. The patient was transported to the ED of thenearest hospital and arrived within 30 minutes of the onset ofchest pain. In route to the hospital, the patient was placed onnasal cannula and an IV D5W was started. Mr. G. received aspirin(325 mg po) and 2 mg/IV morphine. He is allergic to meperidine(rash). His pain has eased slightly in the last 15 minutes but isstill significant; was 9/10 in severity; now7/10. In the ED, chestpain was not relieved by 3 SL NTG tablets. He denies chills.
Case Study Questions
- For patients at risk of developing coronary artery disease andpatients diagnosed with acute myocardial infarct, describe themodifiable and non-modifiable risk factors.
- What would you expect to see on Mr. W.G. EKG and which findingsdescribed on the case are compatible with the acute coronaryevent?
- Having only the opportunity to choose one laboratory test toconfirm the acute myocardial infarct, which would be the mostspecific laboratory test you would choose and why?
- How do you explain that Mr. W.G temperature has increased afterhis Myocardial Infarct, when that can be observed and for how long?Base your answer on the pathophysiology of the event.
- Explain to Mr. W.G. why he was experiencing pain during hisMyocardial Infarct. Elaborate and support your answer.
