MosaicED Brain Teaser!
A 60 year old Marlboro man walks into the ED oozing coolness. He pulls a Virginia death stick out of his chest pocket and lights up. Slowly he raises his head revealing his ruggedly good looking face that had been hidden by his hat. He says something to you but you don't hear it because all you see is his oceanic blue eyes staring into yours, staring into your soul and beyond it to oblivion. Your heart is screaming "Take me you beautiful man, TAKE ME ALL THE WAY!"
"Sorry, I didn't catch that can you say that again," you ask him.
He takes a another long drag of his cigarette and says "I have crushing central chest pain that goes into my left arm. I am really short of breath and am very nauseous, I want to vomit."
What is the most likely diagnosis?
- A-Acute myocardial Infarct
- B-Exertional angina
- C-Bornholm disease
- E-Dissecting thoracic aneurysm
- F-Gastro-oesophageal reflux
- G-Pulmonary embolism
- J-Unstable angina
A-Acute myocardial Infarct.Common heart attack signs and symptoms include: Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back, Nausea, indigestion, heartburn or abdominal pain, Shortness of breath, Cold sweat, Fatigue, Lightheadedness or sudden dizziness
Acute Myocardial Infarction - Treatment: revascularization, PCI, CABG, Thrombolysis - streptokinase, causes extra production of plasmin, which breaks down fibrin, the main component of blood thrombi
Acute: Morphine, Nitrites, Aspirin, Statins, heparin
Ongoing: Statin, atorvastatin, Ace inhibitor, Antiplatelet - aspirin, beta blocker, clopidogrel: antiplatelet
irreversibly inhibits the ADP receptor on platelet cell membranes
Path changes: <24hours - nothing, 24-72 hours necrosis, 3-7 days macrophage infiltration
complications: Contractile dysfunction - cardiogenic shock, Arrhythmia, Sudden death, dresslers pericarditis - 2-3 week post, myocardial rupture, mural thrombosis, left ventricular aneurysm