Question

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CLINICAL CASE 2 CARDIOVASCULAR SYSTEM Clinical Case 2 A 61 year old AAF was admitted to the hospital with a worsening of abdominal pain, upset stomach with heartburn, nausea, and vomiting. The pain and symptoms started 2-3 days ago. The antacid medication made her well until the morning of this day. Physical examination shows tenderness of the RLQ of the abdomen, but soft and no rebound. An ECG shows numerous abnormal beats and marked deviation of the segment S-T. CPP was positive, showing troponin elevation, cardiac CK (creatine kinase), in addition to elevated blood glucose levels. Shortly after admission, she suffered cardiac arrest and died. Questions 1. What is your diagnosis? Diverticulitis, Appendicitis, etc? 2. How is your diagnosis based on the physical examination and ECG? 3. What do the lab data demonstrate? 4. What has caused the cardiac arrest? 5. Are the starting and course of the disease typical or not? Explain. 6. Is it true that there is a "cardioptosis of old age"? The heart migrates down towards the abdomen with age.

Answer 1

1, Appendicitis, diverticulitis, Hyperglycemia, Myocardial infarction, cardiac myopathy
2, Physical examination
Right lower quadrant tenderness of the abdomen, soft and no rebound indicate there is less chance for appendicitis because in appendicitis or peritonitis there will be rebound tenderness present.
ECG shows abnormal beats and the ST segment deviation indicates acute myocardial infarction and arrhythmias.
3, Troponin elevation indicate myocardial ischemia or injury
elevated cardiac CK indicate cardiac muscle dystrophy or cardiomyopathy
High blood glucose level indicates hyperglycemia.
4, When there is a severe coronary artery disease, it can increase the ventricular fibrillation it can cause cardiac arrest. There is cardiomyopathy that happens when heart muscle walls are thickened and enlarge make arrhythmias. patient glucose level is high. the patient had symptoms of heartburn, abdomen pain in the RLQ and nausea and vomiting it is a symptom for worsening cardiac disorder.patient is 61 years of old there is also one cause for cardiac disease and arrest.
5, starting and course of the disease typical. because the patient had cardiac symptoms 3 days which was considered an abdominal disorder. The patient came to the hospital when the condition worsens. In this case, RLQ pain is not due to Appendicitis.
5,