Question

History of Present Illness H.J. presented to the emergency department (ED) late one evening complaining of a "racing heartbeat". She is an overweight, 69-year-old white female, who has been experiencing increasing shortness of breath for the past two months and marked swelling of the ankles and feet for the past three weeks. She feels very weak and tired, most of the time and has recently been waking up in the middle of the night with severe breathing problems. She has been sleeping with several pillows to keep herself propped up. Five years ago, she suffered an anterior wall (left ventricle) myocardial infarction (MI). She received coronary artery bypass surgery 4 2 years ago for obstructions in the left anterior descending and left circumflex coronary arteries. The patient is admitted to the hospital for a thorough examination.

Answer 1

4. Hypercholesterolemia for the past 9 years  is the likely cause for H.J's heart failure.

Heart failure is a gradual process in which the presence of weak muscles of the heart causes inadequate pumping of the blood to the cells.Here,the ejection fraction is only 36 %(normal ejection fraction is 50-75%).Since H.J has hypercholesterolemia for the past 9 years,coronary arteries which supply blood to the heart muscle might have narrowed due to the cholesterol deposits for long and blood get accumulated.Chest xray shows prominent cardiomegaly.

5.The risk factors could be

• Family history of heart attack

H.J's father died of heart attack due to artherosclerosis.So a first degree male relative's or female relative's heart attack is considered a risk factor for developing heart attack.

• Smoking

H.J was a smoker who smoked 3 packets per day.The nicotin present in cigarettes develops blood clots leading to heart attacks or the lining of the blood vessels will be affected.

• Obesity

Obesity leading to hypercholesterolemia could be the other risk factor.

6. Aspirin is an antiplatelet drug.Since she has hypercholesterolemia,artherosclerosis should be prevented as it further promote heart attack.She also has a history of heart attack.