Case #4 A forty-five year old engineer presents to the ER complaining of a sever

Question

Case #4 A forty-five year old engineer presents to the ER complaining of a severe, intense, precordi sensation with pain radiating to the left shoulder and down the inside of the left arm, triggered h exercise. The chest discomfort brought on by the exertion is relieved by rest. ER examin the following: ninety-eight beats/min heart rate, blood pressure of 160/110 mmHg, and of twenty-four breaths/min. EKG is performed and reveals ventricular extrasystole arrhyhm (premature ventricular contraction [PVC) as well as ST segment depression and decreased R-wave height. An exercise tolerance test is performed which demonstrates a downward sloping ST Coronary angiography shows luminal obstruction >75 percent (91 percent) in three major coronary vessels, including the left anterior interventricular (descending) coronary artery. The patient is started on nitroglycerin, beta-blockers, and calcium channel blockers. Angioplasty is scheduled for the next morning. al, crushing a respiratory rate segment. What is the term for the chest pain experienced by this individual . .What is the diagnosis? . Calculate this patient's mean arterial pressure 29

Explanation / Answer

The chest pain experienced is due to ventricular extrasystole arrythmia.

Diagnosis is heart rate of 98 bpm, BP of 160/110 mm Hg, Respiratory rate of 24 breaths/min.

Mean arterial pressure = 1/3 * systolic BP + 2/3 * diastolic BP

= 1/3 * 160 + 2/3 * 110

= 126.6 mm Hg

Nitroglycerin is given to prevent angina. It works by relaxing and widening blood vessels so blood can flow more easily to the heart. Beta blockers are given to reduce blood pressure and to manage heart failure. They work by blocking the effects of epinephrine(adrenaline) and slowing the heart's rate, thereby decreasing the heart’s demand for oxygen. Calcium channel blockers relax blood vessels and increase the supply of blood and oxygen to the heart while also reducing the heart's workload.

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