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John, an overweight 49-year-old man with history of diabetes and hypertension is playing soccer. After half an hour of an intense game, he feels severe chest pain that travels to his lower jaw. He is pale, diaphoretic, and short in breath. Upon arrival to the ER, an ECG was taken and the results show the following (note the changes in leads II, III and aVF):

Choose 3 out of the 5 prompts and answer:

  1. What could be the possible reason for John’s chest pain? Explain your answer based on the clinical information.
  2. How do you know John’s chest pain is heart related? How do you rule out other etiologies of chest pain such as musculoskeletal, pneumonia, and gastric sources?
  3. What actions should John’s teammates have taken at the scene to help him?
  4. How do you differentiate between myocardial ischemia and myocardial infarction?
  5. What is TPA? Explain how it relieves the chest pain and how it improves the survival rate in a patient with acute myocardial infarction.

comment 1

2. How do you know John’s chest pain is heart related? How do you rule out other etiologies of chest pain such as musculoskeletal, pneumonia, and gastric sources?

John has hypertension and diabetes that are risk factors for cardiovascular complications. The pain is characteristic for acute myocardial infarction while shortness of breath, pallor, and diaphoresis support the diagnosis. Additionally, the ECG confirms irregularity of heartbeats, showing the heart relation of the symptoms (Ferry, et al., 2019). Ruling out musculoskeletal, pneumonia, and gastric sources requires obtaining the ECG and carrying out laboratory studies on cardiac biomarkers particularly cardiac troponin levels (Mechanic & Grossman, 2020).

References

Ferry, A. V., Anand, A., Strachan, F. E., Mooney, L., Stewart, S. D., Marshall, L., . . . Shah, A. S. (2019). Presenting Symptoms in Men and Women Diagnosed With Myocardial Infarction Using Sex‐Specific Criteria. Journal of the American Heart Association, 8, 1-16. doi:https://doi.org/10.1161/JAHA.119.012307

Mechanic, O. J., & Grossman, S. A. (2020). Acute Myocardial Infarction. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459269/

comment 2

5. What is TPA and explain how it relieves chest pain and how it improves the survival rate in a patient with Acute Myocardial Infarction?

Tissue plasminogen activator (tPA) is named a serine protease (compounds that separate peptide securities in proteins). It is, in this manner, one of the essential segments of the disintegration of blood clusters. Its vital capacity incorporates catalyzing the change of plasminogen to plasmin, the primary protein associated with dissolving blood clusters.
Recombinant biotechnology has permitted tPA to be made in labs, and these manufactured items are called recombinant tissue plasminogen activator (rtPA). Instances of these medications incorporate alteplase, reteplase, and tenecteplase. These medications have experienced different changes to intensify their pharmacokinetic and pharmacodynamic properties. Particularly to draw out their short half-life in the dissemination and further increment their fibrin explicitness, to forestall an undesirable fibrinolytic state.

Citation:

Thrombolytic therapy: MedlinePlus medical encyclopedia. (n.d.). MedlinePlus – Health Information from the National Library of Medicine. https://medlineplus.gov/ency/article/007089.htm


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