Mrs. William’s. is a 67-year-old housewife, who was admitted to the emergency department complaining of severe chest pain after her daily walk at a nearby park. she received aspirin 300 mg. On arrival at hospital by physical examination and review by the admitting doctor the following information is found.
Previous medical history
Hypertension (17 years). Type 2 diabetes mellitus (4 years ago on metformin ).
The patient is a regular cigarette smoker (>20 per day) and drinks approximately 15 units of alcohol per week. She has osteoarthritis of the knee.
Family history:
Mother died following a myocardial infarction at 70 years of age. No Paternal history of
cardiovascular disease.
Drug history
Allergies: Sulphonamides .
Mrs. Williams. has been taking Ibuprofen200 mg every 12 hours and
nifedipine (Adalat Retard) MR tablets 20 mg (twice daily). Both were stopped on admission.
Signs and symptoms on examination
▪ Temperature 98.1 F
▪ Blood pressure 150/82 mmHg
▪ Heart rate 80 bpm, regular
▪ Respiratory rate 16 breaths per minute
▪ No basal crackles in the lungs.
An ECG taken immediately on arrival reveals ST elevation of 3 mm in the inferior leads. 1 and 2 and AVF
Diagnosis
A preliminary diagnosis of myocardial infarction is made.
Relevant test results
Full blood counts, liver function tests, electrolytes and renal function, CXR, total cholesterol, full
blood count and blood glucose were taken at admission.
1. What further diagnostic and laboratory tests should be ordered to help confirm the
diagnosis?
2. What is myocardial infarction and what are the classic and none classic symptoms?
3. What is the role of thrombolytics such as alteplase in acute myocardial infarction?
4. What is the maintenance dose of Heparin the patient should receive after initial dose?
5. Patient is going to get atorvastatin daily, what counseling should the patient receive regarding the side-effects of atorvastatin ?
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