A 40-year-old diabetic woman was evaluated in the emergency room for chest pain.
ID: 97873 • Letter: A
Question
A 40-year-old diabetic woman was evaluated in the emergency room for chest pain. She had a history of hypertension and a 30 pack-year smoking history. Her medications included anti-hypertensives and cholesterol-lowering agents. She had a prior admission several years ago for a small, uncomplicated, myocardial infarct. She had had angina for many years, averaging one bout of angina a week. Her usual angina lasted 10-15 minutes and was relieved by nitroglycerine. A cardiologist attempted angioplasty several years ago. This procedure relieved her symptoms for six months, but eventually exercise-induced angina returned. There were no clinical changes two weeks prior to her emergency room admission, when she began having daily anginal attacks that lasted 30 minutes or more.
In the hour prior to her admission, she had awakened with severe chest pain, nausea, and dyspnea. There had been severe unrelenting pain for 45 minutes, and it had not been relieved by nitroglycerine. Vital signs: HR 105, BP 100/50 (her usual BP was about 155/95), temp. 100¡F. She was obese and diaphoretic (sweating profusely) with pale skin and labored respirations. Rales were heard over both lung fields. An EKG and serial cardiac markers were ordered.
Lab Values:
Time
Total CK IU
CK MB ng/ml
CK index
Troponin ng/ml
Admission
150
3
20
<0.4
8 hrs
32
8
25
0.8
16 hrs
500
30
60
10.4
24 hrs
750
60
80
22
48 hrs
300
18
60
14
72 hrs
80
2
25
9.3
Normal
38-120
0-3
0-3
<0.4
What were the predisposing risk factors that brought about the cause of the disease? Explain.
Time
Total CK IU
CK MB ng/ml
CK index
Troponin ng/ml
Admission
150
3
20
<0.4
8 hrs
32
8
25
0.8
16 hrs
500
30
60
10.4
24 hrs
750
60
80
22
48 hrs
300
18
60
14
72 hrs
80
2
25
9.3
Normal
38-120
0-3
0-3
<0.4
Explanation / Answer
The predisposing factors that caused angina in this patient are hypertension and 30 pack year smoking history. High blood pressure damages coronary arteries and it causes build up of atherosclerotic plaques which cause obstruction to the normal blood flow to cardiac myocytes leading to angina. Smoking changes the lining of blood vessels. The walls of coronary arteries are hardened and lumen is narrowed due to formation of atherosclerotic plaques. The oxygen carrying capacity of blood is also affected because of the effect of carbon monoxide in tobacco smoke.
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.