Case #1: AMIPRESENTED BY AMI ALANIZ

Present Illness 53 year old white male

chest discomfort while playing tennis

became crushing sensation in sternal area and spread to jaw

tennis partner called 911

arrived at hospital within 30 minutes of onset chest pain

Medical Treatment So Faro nasal cannulae

o 5% dextrose in water

o 325 mg aspirin

o 2 mg intravenous (IV) morphine

o sublingual nitroglycerin (SL NTG) tablets

oExperienced 0 effects

Predisposed?

Medical History ulcerative colitis – 22 years

hypertension – 12 years

type 2 diabetes mellitus – 5 years

post acute myocardial infarction 5 years ago

chronic stable angina – 4 years

benign prostatic hyperplasia

hypertriglyceridemia

adenomatous colonic polyops

Histology: Athersclerotic Plaque Cross Section

Femoral Atherosclerotic Artery

Percutaneous Transluminal Coronary Angioplasty

Familial & Social History father died from myocardial infarction at age 55

also had diabetes mellitus

sister, age 52, no reported health issues

brother, age 44, with hypertension

history of cigarette smoking

recurring chest pain with physical activity for the past month

Medications Amlodipine: 5 mg every morning

Glyburide: 10 mg every morning, 5 mg every night

Aspirin regimen: 325 mg daily

Gemfibrozil: 600 mg twice daily

sulfasalazine: 1.5 grams twice a day

terazosin: 1 mg before bed

In the Hospital

Patient Chart High Blood Pressure: 160/98

Temperature: 98.2

Height: 5’ 10 ½”

Weight: 184

tachycardia with an occasional premature beat

bibasilar inspiratory crackles with auscultation

bilateral mild pulmonary edema

Pulmonary Edema

Normal vs Edema

Two Days Into His Stay… stable until he began to experience chest pain again

“emergency angiography revealed a 95% obstruction in the left anterior descending coronary

artery”

consistent with completed acute myocardial infarction

percutaneous transluminal coronary angioplasty was successfully performed

successful placement of stent

Happy Ending?o gradually ambulated

o physical activity slowly increased

o discharged eight days post-AMI