Question

Patient Profile: CAD is a 45 year old male who has had anginal pain that occurs with exertion. When he rests, it goes away. Today his pain has been more severe and not decreasing with rest. He has associated nausea/vomiting, diaphoresis and shortness of breath. He is seen in the ED and determined to have a myocardial infarction. He has a history of hypertension, diabetes type 2, elevated cholesterol. He is 5'10" and weighs 265lbs. He smokes 1 pack/day, denies regular exercise and eats out often. Critical Thinking Questions: 1. Describe the mechanism responsible for the anginal pain he was having initially. 2. Discuss how his myocardial infarction differs from the angina in relation to pathological mechanisms. 3. Please discuss how each of his risk factors contribute to his risk of MI.

Answer 1

solution;

1.MECHANISM RESPONSIBLE FOR ANGINAL PAIN

Anginal pain is the most common clinical symptom of myocardial ischemia.The anginal pain is caused by the chemical and mechanical stimulation of sensory nerve endings in the coronary vessels and myocardium.

• Decreased coronary blood flow and increased oxygen consumption leads to the anginal pain or chest pain.Vasospasam ,fixed stenosis and Thrombosis leads to decreased coronary blood flow.
• Increased heart rate,contactility, preload,afterload etc may leads to the increased amount of oxygen consumption.
• Above factors leads to an imbalancr betwwen the oxygen demand and oxygen supply.
• This imbalance can result from an increase in demand(eg.during exercise) without a propotional increase in supply(eg.due to obstruction or atherosclerosis of the coronary arteries.

2. MECHANISM RESPONSIBLE FOR MYOCARDIAL INFRACTION

Myocardial infraction or heart attack is the reversible damage of myocardial tissue caused by prolonged ischemia and hypoxia.Collateral blood flow is an important determinant of infract size and whether or not the boredr zone becomes irreversibly damaged.

Pathophysiology of myo Casdeal Intsat non. Atherosclesosis Atherosclerosis I plaque obst suchon split Theombus occlusion Dschaemia Hypoxia Reduced og demand -> Angina Thrombolysis pesmanan I Thrombus Necrosis Myo Casorial infrachon

3.RISK FACTORS AND MYOCARDIAL INFRACTION

• SMOKING;Cigerette smoking increases the risk of inferior wall acute myocardial infraction more than the risk of anterior wall infraction.Smoking thus appears to adverslely affect the right coronary arterial circulation to greater extent the left coronary arterial circulation.
• EAT OFTEN\OVER EATING;Eating and digesting food boots blood levels of hormones that raises the blood pressure and heart rate.
• LACK OF EXERCISE; lack of physical activity cause blood clot,high blood pressure,heart attack etc.