Medical Case Study

 The Case study described is for a patient undergoing a diagnosis for Acute Myocardial Infarction (AMI). The diagnosis of AMI occurs when a patient has typical fluctuations in the cardiac biomarkers indicating myocardial necrosis combined with other signs to signify the injury to the myocardium. The case study intends to shed more light on the diagnostic procedures that help in the identification and treatment of Acute Myocardial Infection and coronary blockage.

Case report

            Paul Richmond is a 63-year old white male who had a history of the chest and back pains. He did not experience difficulty in breathing and vomiting, but he felt nausea. The laboratory tests and the EGK data showed acute myocardial infarction. The patient was also under the CCU for few days for monitoring and evaluation by cardiology. Upon catheterization, it revealed stenosis in two coronary arteries. The corrective measure administered was Percutaneous transluminal coronary angioplasty (PTCA). PTCA corrected the artery stenosis, but the processes leading to its development remains.

Laboratory data

            The patient underwent various tests including chest and back X-rays, EKG, and blood gas. 

            Cardiac catheterization procedure is interventional in nature and is a diagnostic procedure for the examination of the blood vessels of the heart. Cardiac catheterization technique provides both diagnostic and therapeutic methodology in a single procedure. It checks for any blockages, narrowing or fat build up. It captures the images of the heart muscles and the surrounding arteries using X-rays. The images provide an ideal picture of the structure of the heart and establish the specific site with an injury. The number of arteries affected or the location of the blockage determines the best mode of treatment.

Percutaneous transluminal coronary angioplasty (PTCA) procedure

            PTCA is a less invasive procedure for opening up the blocked arteries allowing the blood to flow freely to the heart muscle. The procedure starts with the doctor injecting some local anesthesia into the groin and inserting a needle into the femoral artery. The doctor places a lead wire through the needle and then removed. The doctor then places an introducer over the lead wire after which he removes it. The practitioner then places a different sized lead wire in its place.
            Next, a narrow tube (diagnostic catheter) is advanced through the introducer over the lead wire into the blood vessel. The catheter is then guided to the aorta and the guide removed. The doctor then injects dye and takes an X-ray after placing the aorta in the opening of one of the coronary arteries. If the doctor notices a treatable blockage, he/she exchanges the first catheter for a guiding catheter. The doctor advances a lead wire across the blockage and then advances a balloon catheter to the site of the blockage. The medical practitioner inflates the balloon for some time to compress the blockage against the artery wall. Then he/she deflates it.

            The procedure may undergo a repetition a few times in which each time the practitioner pumps up the balloon further to widen the passage for blood. There may be several repeats at every blocked site in the coronary arteries. The practitioner may place a stent within the coronary artery to enhance the opening. After compression, a contrast medium is injected, and an X-ray performed to check for any changes in the arteries. The practitioner then removes the catheter, and the procedure comes to an end.

            The patient was in the emergency department where he underwent the chest and back X-rays. The tests helped in ascertaining the likely illnesses identified. The X-ray helped to identify the cause of the pains by close examination of the radiographs. Chest X-rays are useful in providing the doctor with a view of both the heart and the lungs. The examination reveals any abnormalities present in the heart and the lungs. The two X-rays scans shown are for a chest X-ray showing a heart on the left. In the right chest X-ray, there is an enlarged heart, and the suggestion is that, the heart main pumping chamber is not in a function. Hence, there is a possibility of a coronary blockage. A chest radiograph and regular blood tests may show complications in the heart vessels. The tests can only occur upon arrival at the emergency department.
            The problems with the heart have the warning signs of chest pains that may spread to the back, shortness of breath, nausea, and vomiting. Coronary artery disease occurs when the plaque narrows or obstructs the coronary arteries thereby resulting in reduced blood flow. The reduced blood flow may cause chest pains and back pains as well.

            The test of the heart disease can be through various modes that include Electrocardiogram, use of X-rays and PCTA. Electrocardiogram (EKG) helps in seeing the heart’s electrical activity. The EKG tests provide information to the physician about the heart rhythm, damage to the heart or a heart attack. The results of EKG can be compared to past and the EKGs to check for any changes in the condition of the heart’s electrical activity.

The diagnosis of myocardial infarction

            When damage to the heart occurs, the levels of cardiac markers rise and thus necessitate blood tests in every 24-hour period. The enzyme levels do not rise immediately upon the heart disease. The patients having chest pains can get treatment with the assumption that a myocardial infarction has occurred and then evaluated for more diagnosis.

Blood gas analysis

            The test measures the PH of the blood and the amounts of oxygen and carbon dioxide in the blood. The analysis measures the partial pressures of the gasses in the blood as well as oxygen content and saturation, bicarbonate content, and the PH. The levels and pressures of oxygen and carbon dioxide determine whether the flow of blood is efficient in the arteries. If the levels are not consistent with the set standards, then the heart may be ineffective in blood pumping.
            The main purpose of the coronary care Unit (CCU) is monitoring of the cardiac rhythm by electrocardiography. The patient was in the CCU for some days to check on the fluctuations in the cardiac rhythm caused by blockages in the blood arteries.

Conclusion
            The diagnostic and treatment procedures on the patient helped to identify the cause of his chest and back pains. Coronary artery stenosis can be corrected by the PTCA procedure. The chest X-rays help to identify any damages on the coronary arteries. The advice given to the patient that he should take lipid-reducing medications helps to limit any deposits of fat in the arteries that may cause blockage. Acute myocardial infarction leads to the myocardial damage that can be treated by cardiac catheterization.

References

Bennett, J. Claude, & Fred Plum,(1996) "Cardiac Catheterization and Angiography." In Cecil      Textbook of Medicine: 20th ed. Vol. 1.Philadelphia: W. B. Saunders Company

Ford, A. (2013). Blood gas analyzers-new tests, new features. CAP Today, 27(8), 15-16, 18-        20,22-24,26. 

Scanlon, Patrick J, et al. (May 1999) ACC/AHA Guidelines for Coronary Angiography 33, no. 6: 1756–1824

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