Title: Acute Myocardial Infarction

By Author: Sherry Roberts
Total Articles: 99
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Clinical History
Paul Richmond, 63-year-old white male. There are no records of earlier diagnosis.
Past medical history
Chest and back pains
Admission diagnosis
His age and symptoms suggest the possibility of acute myocardial infarction, given his previous symptoms. Chest pains are usually referred to angina and usually on the chest, back or jaw.
Laboratory findings
Laboratory tests and data showed acute myocardial infarction. There was stenosis in two coronary arteries with catheterization. The heart's main pumping chamber is dysfunctional. That is a diagnostic sign of coronary blockage. Also, radiograph and blood tests show complications in the heart vessels. More tests ordered include Electrocardiogram, X-rays and PCTA. The signs of a damaged heart are marked rise in cardiac markers. The results also showed decreased pH, SaO2 and bicarbonate with other increases in PaO2 and PaCO2. Other test procedures confirmed Coronary artery stenosis.

Tabular laboratory results
Patient result Normal range

Arterial blood pH
7.36 7.38 to 7.42
Partial pressure of ...
... oxygen
(PaO2) 105 mmHg 75 to 100mmHg
Partial pressure of carbon dioxide (PaCO2) 44mmHg 38 to 42 mmHg
Oxygen saturation (SaO2)
91% 94 to 100 %

Bicarbonate (HCO3)
20 mEq/L 22 to 28 mEq/L

Electrocardiogram results
Patient results
Normal range
P-R Interval 0.18 sec
0.12 to 0.20 sec
QRS Interval 0.11 sec
Less than 0.10 sec
Q-T Interval 0.42 sec
0.30 to 0.40 sec

Questions
1. Elaborate on the electrocardiogram results. Why are they varied from standard results?
2. His chest x-ray is abnormal. What explains the structure of his chest?
3. What causes chest and back pains in acute myocardial infarction?
4. What are the factors for high-risk and low-risk myocardial infarction?
5. What are the reasons behind the electrocardiogram results?
Possible Answers
Coronary arteries supply the heart with oxygen-rich blood. When plaque blocks these arteries, coronary artery stenosis occurs. The commonest symptom related to acute myocardial infarction is severe chest pains. These are also called angina and may spread to other parts of the body. Sometimes, there may be other symptoms but the most notable ones are nausea and shortness of breath. Cardiac markers elevation is useful for tracking ongoing infarction. Re-elevation and subsequent decrease in their levels indicate infarct expansion or recurrent infarction respectively.
The heart undergoes the two processes of depolarization and repolarization, the electrical currents resulting travel throughout the body. The electrical activity coming from the heart is measurable using an electrocardiogram test. The period between the onset of the P wave and the start of the QRS complex is the P-R interval. The standard ranges are between 0.12 and 0.20 sec. It represents the onset of atrial depolarization and ventricular depolarization. Results showing >0.2 sec duration indicate an atrial, ventricular conduction block.
The length of the QRS complex ranges from 0.06 seconds to 0.1 seconds in average heart rates. Anything longer indicates impairment in conduction in the ventricles. The last variable is the Q-T interval. It is a representation of the time duration for ventricular depolarization and repolarization to happen. The greatest range is from 0.2 seconds to 0.4 seconds. When the heart rate is high, the Q-T interval is short. Excessively long-range may be an indicator of susceptibility to heart attack. The patient’s ECG is not within the normal ranges and, therefore, there is the confirmation of the results, coupled with the outcome of the blood gas test. Factors for high-risk acute myocardial infarction include smoking, diabetes, high cholesterol and family history.

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