PATIENT CASE:_______________________________________________________________________ Patient X is a 52-year-old man who lives in Bowen Hills, Brisbane. He is an automotive repair man. However, he has recently lost his job and has stayed idle for one year. Recently, he was playing basketball with his eldest son and suddenly developed a substernal chest pressure. When he thought it was just a typical ‘heartburn’, he continued playing. After another 20 minutes, he had an intolerable sharp, nagging chest pain. His left arm became numb. His son verbalised that he looked pale and was sweating a lot. His son called the paramedics which accordingly arrived after 30 minutes and he was brought to Royal Brisbane and Women’s Hospital. Patient X has previous history of hypertension and MI, with no family history of diabetes mellitus. Social history revealed sedentary lifestyle and alcoholism related to recent job loss. He smokes but does not take recreational drugs.
Initial assessment by the paramedics revealed RR 26 cpm, HR 98bpm, BP 135/80 mmHg, and O2 sat 96%. Patient scored his chest pain with 9 on a scale of 1 to 10. His left arm was numb and he was diaphoretic. A cardiac monitor was placed, and revealed a sinus rhythm with ST elevation of greater than 0.1mm with a presumably new bundle branch block. There was presence of Q waves in II, III and aVF leads with no other abnormalities. In route, a nasal cannula was placed with oxygen at 4 L. His vital signs remained unchanged. The chest pressure remained the same at 9 out of 10. Nonenteric-coated aspirin 325 mg was given to chew along with sublingual nitroglycerin 0.4 mg and morphine 2 mg IV. The cardiac monitor remained in place during transport. Hospital laboratory tests revealed total serum cholesterol of 160 mg/dl, HDL cholesterol of 55 mg/dl, triglycerides of 78 mg/dl, LDL cholesterol of 89.6 mg/dl and fasting glycemia of 116 mg/dl, with a normal OGTT and normal plasma homocysteine. His attending physician...
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