Patient with chest pain

_

Mrs. L.L. (53 years old) came to the cardiology emergency room.

The doctor took following history:

History of presenting complaint:

So far no heart disease. In the evening (19.2.2013) she had a rest chest pain with a propagation to the left upper extremity. It resolved spontaneously. In the morning of the next day (20.2.2013) our patient felt the same pain again (with alternating pain intensity). It mitigated partially in absolute rest. At 13.15  (20.3.2013) patient had an intense chest pain that did not mitigate even after one hour. Her husband brought her to the cardiology emergency room. She had no shortness of breath or other complaints.

Past medical history:

Appendectomy and infectious mononucleosis in childhood. Do not remember years precisely.

Abuse:

15 cigarettes a day. Alcohol: only occasionally

Family history:

Father died in 57 years – lung cancer, mother died in 72 years – stroke, sister (61 years) after aortocoronary bypass, 2 healthy children

Gynaecological history:

menarche in 13 years, 2 spontaneous births, miscarriages 0, menopause in 51 years

Pharmacological history:

0 (only occasionally Ibuprofen 400 for headache)

Social history:

Administrative officer

Allergy history: 0

Physical examination:

160 cm / 82 kg, BMI 32, heart rate 72/min, blood pressure 110/70 mm Hg

Patient alert, oriented, eupneic, without cyanosis, freely movable

Lungs: Clear to auscultation and percussion without rales, rhonchi, wheezing or diminished breath sounds.

Heart: Normal S1 and S2, no murmurs. Rhythm is regular.

Otherwise physiological finding

ECG: findings consistent with an occlusion of right coronary artery

The doctor ordered laboratory tests. Here are the results: (only selected findings)

Troponin I  28 ug/l

CK  8.5 ukat/l (normal range 0.2-2.6ukat/l)

CK-MB  5.9 ukat/l (normal range 0-0.42ukat/l)

Total cholesterol  8 mmol/l

HDL  1.6 mmol/l

LDL  5.2 mmol/l

Triglycerides  2.59 mmol/l

Fasting glucose  6.2 mmol/l

Questions:

How would you assess the levels of lipids and glucose in plasma ?

What is the physiological importance of cholesterol in the human body ?

Briefly describe the transport of lipids in the blood.

            Our patient was transported directly to the catheterization room for urgent coronary angiography.

Coronary angiography: 100% occlusion of the right coronary artery. Procedure to restore blood flow performed immediately with optimum effect. During the procedure, heparin and aspirin were administered (heparin to a total dose of 200 units/kg and aspirin 500 mg iv). Patient felt no chest pain after the angiography.

Questions:

For the diagnosis of myocardial infarction are crucial laboratory tests. Do some lab results suggest that our patient has a myocardial infarction? What is the role of these compounds in the metabolism of the heart muscle?

Why was during the procedure administered heparin and aspirin?

 

Further course: completely without complications. Patient could be sent home after one week.

Questions:

One of the risk factors of coronary heart disease is elevated blood cholesterol level. To decrease it doctors widely use drugs that block one enzyme of lipid metabolism. What is their name and what is their mechanism of action?