Question

Case presentation

Jane remembers feeling very hot, stressed and confined in her car on the expressway as she was on her way down to an important meeting. “I was getting very agitated because the traffic was at a standstill and I only had just over an hour to get there. I knew I wasn’t going to make it,” she remembers.

As she sat in the traffic jam, she began to feel unwell and experienced an aching pain in her chest, which went out through her shoulder and all the way down her arm. “I thought I had cramp but then I was having real difficulty getting my breath and I felt hot and really sick,” she says.

Jane does not recall anything after that but, fortunately, the traffic was at a complete standstill because of an accident up ahead and when she opened the car door and collapsed in the road, the motorists waiting in the queue behind her rushed to Jane’s aid. Jane was transported to a local emergency room for treatment and follow up care.

Jane is 56 years old,is mostly sendentary (< 30 minutes exercise/day), smokes occasionally (< 1 pack/week) and consumes < 7 alcoholic drinks/week.

1. Using the data below, and the case presentation, identify risk factors in this case. (5)

Test	Result	Normal Range
BMI (weight: 210 lbs Height: 5’8”)	31.9	18.5–24.9
Triglycerides (mg/dl)	225	< 150
High-density Lipoprotein (mg/dl)	42	≥ 40
Low-density Lipoprotein (mg/dl)	95	< 100
Blood Pressure (mm Hg)	155/95	90–120/60–80
Pulse	90	60–100
Hematocrit (%)	40	36–50
Hemoglobin (g/100 ml blood)	12.4	11–14
Glucose (mg/dl)	140	75–105
Sodium (mmol/L)	140	135–145
Potassium (mmol/L)	4.5	3.5–5.0

2. Which additional blood tests are commonly used to diagnose cardiace muscle damage?

Identify the test, and the purpose of the test in test validity terms (sensitive, specific, predictive value)

3. Identify three additional non-lab procedures used in the diagnosis of damage to cardiac muscle and explain how these are used (5)

Example:

EKG: measures electrical conduction and rhythm. Changes in the EKG along with blood tests can indicate cardiac muscle damage.

Answer 1

1. Risk factors of this patient besed on lab values and case presentation are,

                                 * Obesity.

                                 * Hypertension.

                                 * Diabetic melitus.

                                 * Smoking.

                                 * Lack of exercise.

2.Lab test to detect cardiac muscle damage

                    * hs -CRP (C reactive protein) test

                          Purpose of test

   * presence hs- CRP indicate risk of developing heart disease in a person.

                          Validity

                                           * If CRP is lower than 1 mg/L indicate low risk of heart disease.

   * If CRP is between 1 mg/L and 3 mg/L then it indicate average risk.

       * If CRP is greater than 3 mg/L indicate high or severe risk of heart disease.

                   * Myoglobin test

                             * myoglobin is commonly found in heart and skeletal muscles but in case of

                                myocardial damage it appears in blood so useful to detect cardiac muscle

                                 injuries.

                       * Troponin (Troponin I and Troponin T)

                               *Normal troponin level is between 0.00 to 0.40 ng/ml.

                               * High troponin levels in the blood indicate presence of cardiac infammation

                                 congestive heart failure, cardiac muscle weakness and negative result indicate

                                 normal test.

                       * BNP(Brain natriuretic peptide)

                                    * This blood test measure the level of BNP protein in the blood which is produced

                                       by cardiac muscles and blood vessel .

                                    * Normal range 125pg/ml in the case of patients aged 0 to 74 years.

                                    * 450pg/ml in the case of patient aged 75 to 99 years.

                                    * More than normal level suspect cardicac muscle damage.

3.Three non lab procedures to diagnose cardiac muscle damage

                    1. Cardiac stress test; It measures hearts response to stress when connected an

                         ECG(Electrocardiogram).changes in stess test along with lab tests indicate

                         cardiac muscle damage.

                     2. Echocardiogram; It detect with the help of sound waves directed to your heart from

                         a transducer placed on your chest and make video images of heart to identify cardiac

                         problems.

                    3. Cardiac MRI or CT; This type of non invasive radiological examinations provide three

                          or two dimensional images of heart which is useful to detect cardiac damages.