(医学各论课件）12、案例Case ofcardiovascular diseas-huhu.doc

Case of cardiovascular disease A 56-year-old male complaining of chest pain is brought to the emergency room by ambulance. The pain began six hours ago and has become more severe over the past hour prompting him to call emergency services. He describes the pain as retro-sternal, pressure-like, and radiate to left shoulder. He endorses some mild dyspnea and nausea accompanying the pain. He has also noted intermittent palpitations since last evening. He has a past medical history of hypertension (not currently under treatment) and tobacco use of 2 packs per day of cigarettes for the past 35 years. He hadn’t seen a doctor in approximately 20 years and thus was unaware of his blood pressure or his cholesterol level. The patient had no history of significant illnesses. He had never been in a hospital and had no surgeries. His father and grandfather both died from “heart disease”. He is a long distance car driver. He is 1.7 meters tall and weights 120 kilogram. Most of his meals were taken in fast food restaurants. He proudly claimed to win a “big stomach king” contest by swallowing 25 hamburgers last year. Vital signs on arrival to the emergency room show a blood pressure of 160/100 mmHg, a heart rate of 92 beats per minute, and a respiratory rate of 18 per minute. His physical exam is unremarkable. He reports no allergies and no medication use. A chest x-ray was performed and lungs were normal. An electrocardiogram was obtained and demonstrated marked ST segment elevation in 2, 3 and AVF (the inferior leads). The initial lab tests showed a marked elevated plasma level of CPK, CK-MB, and Troponin T. He was given intravenous metoprolol (a beta-blocker), together with an angiotensin converting-enzyme inhibitor, two aspirins and clopidogrel was given. An angiogram was performed. His coronary angiogram demonstrated complete occlusion of the left anterior descending coronary artery. The rest of the coronary artery was without disease. An angioplasty catheter was placed in t