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Case #1: AMI

Case #1: AMI. Presented 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.

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Case #1: AMI

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  1. Case #1: AMI Presented by amialaniz

  2. 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

  3. Medical Treatment So Far • nasal cannulae • 5% dextrose in water • 325 mg aspirin • 2 mg intravenous (IV) morphine • sublingual nitroglycerin (SL NTG) tablets • Experienced 0 effects

  4. Predisposed?

  5. 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

  6. Histology: Athersclerotic Plaque Cross Section

  7. Femoral Atherosclerotic Artery

  8. Percutaneous Transluminal Coronary Angioplasty

  9. 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

  10. 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

  11. In the Hospital

  12. 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

  13. Pulmonary Edema

  14. Normal vs Edema

  15. 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

  16. Happy Ending? • gradually ambulated • physical activity slowly increased • discharged eight days post-AMI

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