Case 1 Mr. Lee by Eugene Macalinga https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv en-us 2023-01-18 02:40:33 UTC 2025-01-21 06:27:16 UTC hello@padlet.com D - STEMI https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746459 Definition: A form of acute myocardinal infarction that occurs in acute coronary syndrome, and is more serious and has a greater risk of serious complications and death 

Causes: Occlusion of one or more coronary arteries, causing transmural myocardial ischemia which in turn results in myocardial injury or necrosis

-Artery is completely occluded by a thrombus. (Transmural Infarction)
-Irreversible myocardial damage due to prolonged ischemia.
-Clinical features: Sudden severe chest pain, Radiation of pain, Common in the morning, Associated with nausea, dyspnea etc.
-ECG Findings: ST elevation
-Invetigations (Serum enzymes): Cardiac Troponin +Ve

Mr Lee: 
- Has PMHx of MI which occurred a year ago
- On three heart medications, but does not take them regularly 
- At risk of STEMI

]]> 2023-01-18 02:41:47 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746459 C - Heart Failure https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746527 Definition of HF: 
- The O2 demand > O2 supply 
- Heart cannot keep up

Risk Factors of HF:
- Alcohol consumption
- Obesity
- Smoking
- Diabetes
- CAD

Symptoms of HF: (anecdotal)
- Chest pain 
- Dyspnea (exertional in early HF)
- Fatigue
- Dizziness
- Hypotension (Low blood pressure)
- Exercise Intolerance
-  Orthopnea 
- Paroxysmal nocturnal dyspnea 

Signs for HF: (upon physical examination)
- A: Cyanosis
- B: Crackles, JVP distension
- C: Edema, pitting in lower limbs, ascites
- D: Fainting (not conscious)

Types  of HF:
- LEFT-SIDED (signs: pulmonary edema - crackles in his lungs)
- RIGHT-SIDED (signs: peripheral swelling)

Case Study:
- Mr Lee has Left-sided Heart Failure (HF).
- Crackles, Low SpO2 (90%) --> Pulmonary Edema
- Increasing dyspnoea on exertion for the past 2 months

]]> 2023-01-18 02:41:54 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746527 G-Cardiac Enzyme: https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746636 - Cardiac troponins I and T: most specific indicators of AMI (can rise for up to 12 hours after a heart attack. They stay elevated for up to two weeks.)
- Lactic Acid Dehydrogenase (LDH1): high levels = myocardium, skeletal muscle or other tissues are damaged
- Creatine Kinase - Myocardial Band (CPK-MB): high levels = inflammation of heart muscle/recently had myocardial infarction 

Mr Lee Laboratory Results
  • Troponin I: 570 microg/L ➡️ Very elevated = indicator of AMI
  • CPK-MB: 16 U/L ➡️ Very elevated = indicator of heart muscle inflammation/recent AMI

]]> 2023-01-18 02:42:01 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746636 Identify risk factors (non-modifiable) https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746797 - age cause he is 68, older people higher risk for CAD because the plaque can build up over time
- male has higher chance than female
- past history of MI as that cannot be modifiable at all now
]]> 2023-01-18 02:42:15 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447746797 B- CAD https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447747946 Definition:
Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis

Risk factors:
Non-modifiable: Genes, gender, age, family history, menopause
Modifiable: Life style (Smoking, obesity, physical inactivity, unhealthy eating), Medication (Dyslipidemia, hypertension, insulin resistance)

Symptoms:
Chest pain> stable angina pectoris
Nausea
SOB

Case Study:
Mr Lee is a high risk pt for CAD due to his age, hypertension, breathlessness. 
His angiogram also shows an 80% thrombotic occlusion.


]]> 2023-01-18 02:44:05 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447747946 R - Subjective data https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447749616 Definition: Symptoms that cannot be measured; information comes from perception 

Mr Lee’s Subjective data:
  1. Crushing chest pain - radiation of pain to jaw/ left upper arm
  2. Increasing dyspnoea on exertion
  3. Need to sleep with head elevated
]]> 2023-01-18 02:46:34 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447749616 A - Risk Factors (Modifiable) https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447751605 - Hypertension 
- Hyperlipidaemia
- Non-compliant on medications (Beta-Blockers, Nitrate, Anti-Platelets, Lipid-Lowering, ACE Inhibitors)
- Possibly physically inactive (retiree)]]> 2023-01-18 02:49:28 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447751605 E - objective data https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447756838 definition: factual information, signs, can be measured through hearing sight smell and touch (physical examination), lab results and vital signs; what have the clinician observe? E.g. mri, ecg, xray, emr

1. RR (26 breaths/min) + SPO2 (90%) + use of accessory muscle  + diaphoretic = dyspnea 

2. pale + cyanotic lip and extremities, cold skin = poor blood circulation 

3. diastolic pressure 90 mmHg = HTN 

4. High WBC (Neutrophil) = signs of bacterial infection &/or injury 

5. Low Potassium = irregular heart rhythm (bradycardia, ventricular tachycardia & ventricular fibrillation) 

6. high tropinin I, CK & CKMB (serum enzyme) = sign of AMI

7. high lipid panel = HIGH risk of CHD

8. ECG (ST Elevation) = sign of AMI


]]> 2023-01-18 02:56:27 UTC https://padlet.com/eugene22_md/kqadjzr5i0vwa4zv/wish/2447756838