57 Years old man with left chest pain
57 year old man experienced several months of vague pains in his left chest and shoulder when climbing stair. During a touch football game at a family gathering, he had much more intense pain and had to rest. After 45 minutes of intermittent pain, his family brought him to a emergency department.
His heart rate is 105 beats/min, his Bp is 105/85 mmHg, and his hands and feet are cool to touch and somewhat bluish. His is sweating and is short of breath. An ECG indicates an elevated ST segment, which is most noticeable in leads V4 to V6 .The attending cardiologist administers streptokinase intravenously. One hour later, the ST segment abnormality is less noticeable. The heart rate 87 bmp, Bp is 120/85 mmHg and patient’s hands are pink and warm and not complain of chest pain and shortness of breath.
During a 4 day stay in the hospital, percutaneous angioplasty is performed to open several partially blocked coronary arteries. The patient is told to take half of an adult aspirin every day and is given a prescription of a statin drug to lower blood lipids. In addition, he is assigned to a cardiac rehabilitation program designed to teach proper dietary habits and improve exercise performance and, together, to lower body fat gradually.
How did the left chest pain during stair climbing predict some abnormality of coronary artery function?
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Filed Under: Discussion
Most likely diagnosis: ST elevation MI?
He displayed acute coronary syndrome.
How did the left chest pain during stair climbing predict some abnormality of coronary artery function?
Let’s see.
57 year old man experienced several months of vague pains in his left chest and shoulder when climbing stair.—>exertional angina
Abnormality of coronary artery function->[Significant plaque where blood flow limited during exertion], chest paiN’s typical of cardiac ischemia that is retrosternal pressure sensation.
During a touch football game at a family gathering, he had much more intense pain and had to rest. After 45 minutes of intermittent pain, his family brought him to a emergency department. An ECG indicates an elevated ST segment.–>
Q wave/transmural myocardial infarction
Abnormality of coronary artery function->[Platelet thrombus on raptured plaque where there's complete vessel occulsion (no lysis)]
Pathophysiology
The resultant clinical syndrome is related to both the degree of artherosclerotic stenosis in the coronary artery and to the duration and extent of sudden thrombotic occulsion of the artery. if the occulsion of the artery is incomplete,or if the thrombus undergoes spontaneous lysis,unstable angina results. if the occulsion is complete and remains for more than 30 mins infarction occurs. In contrast, the mechanism of chronic stable angina is usually a flow limiting stenosis caused by atherosclerotic plaque that causes ischemia during exercise without acute thrombosis.