Exposicion de caso clínico,exposicion final de curso Inglés Médico II. USAT. medicina

1. ENGLISH
Clinic case
ENGLISH
Clinic case
Saturday 28th 2015Saturday 28th 2015
 Irene Marleny Soriano
Villalobos
 Jerson André Vigo
Rabanal
 Carlos Felipe Chero
Gallardo
 Irene Marleny Soriano
Villalobos
 Jerson André Vigo
Rabanal
 Carlos Felipe Chero
Gallardo

2. A male patient of 48 years old
arrive to the emergency service
to the Regional Hospital; he
comes with his friends; the
patient refere that they was
playing soccer and he felt a
pain in the chest for three
opportunities; the first two times
the pain was calmed when he
stopped to play but in the three
time do not calm for this motive
he comes to the hospital.

3. LIFE STILE
The patient smoke 5 cigars for
day and dont have much fisic
activity; he only plays soccer
one time at the month.
FAMILIARY ANTECEDENTS
His father died at 55 years
caused for a hearth attack
The patient indicate that
the pain is behind the
sternum and the kind of the
pain is oppressive; and the
pain is reflected in the left
arm too; this symptom start
one hour ago.

4. Fisic Exam
Arterial Pressure: 130/89 mmHg
Heartbeat: 80 lpm
Respiratory Frecuency: 22 rfm
Temperature: 36,5 ºC
Stature: 1,60 mt.
Weight: 85 kg
Abdominal Circunferency: 110cm
Body mass index: 32,2

5. Acts:
• Patient male
• Arrive to Emergency service of the Regional Hospital.
• Comes accompanied with his friends
• He was playing soccer
• Smoker and sedentary life.
• His father died for a head attack.
Health Problems:
1.- pain in the chest of kind oppresive
2.- the pain is reflected in the left arm
3.- Obesity
4.- Arterial Hypertension
5.- Style of life unhealthy
Case AnalysisCase Analysis

6. Associated factorsAssociated factors
 Age
 Sex
 Family history
 Age
 Sex
 Family history
 Tobacco
 Hypercholesterolemia
 Hypertension
 Diabetes
 Obesity
 Alcohol
 Emotional distress
 Tobacco
 Hypercholesterolemia
 Hypertension
 Diabetes
 Obesity
 Alcohol
 Emotional distress
Unchangeable Modifiable

7. AFFECTED STRUCTURE
THE HEART
• Is a muscular organ that is the main part of
the circulatory system, It is the responsible
for pumping blood to all the parts of the
body
• Is divided in 4 cavities; this cavities are left
and right atrium, left and right ventricles ;
the part of the right heart have blood with
few oxygen and the part of the left heart
have blood with so much oxygen.
• Is an self controlled organ because it have
some muscular fibres that have
modification and generate electric pulses.
the heart have two fases; the first one called sistole
(contraction) and the other called diastole
(chamber filling)

8. The irrigation of the heart is by the coronary arteries; this
arteries are originated in the ascendant part of the aorta
artery; specifically in the aortic sinuses or sinuses of Valsalva
both the right and left side.
The coronary arteries are two : the right coronary and the
left coronary
 The left coronary is divided in descending anterior artery
and the circunfleja artery. This arteries are responsible of
the irrigation to the anterior and lateral part of the left
ventricle.
 The right coronary is divided in descending posterior
artery that is the responsible of the irrigation of the lower
wall of the heart
There are different types of coronary diseases but the most
frequent and most clinically relevant is coronary
atherosclerosis and it can be produce to ischemic heart
disease.

10. Male patient
48 years
Myocardial
infarction
Blood flow Poor blood
supply
Tissue
damage
Obstruction
Atheroma
Personal
record
Obesity
Excessive fat intake
LDL
HDL
Chest
pain
Oppressive
Retroesternal
Referred to
left arm
Emergency
Sick time: 1 hour
Endothelium
of arteries

11. Decreased
tissue
oxygen
Peripheral
chemoreceptors
Pulmonary
ventilation
Activation of
vagal
receptores
(acetylcholine)
Cardiac
contractility
Sweat glands
(diaphoresis)

12. Acute ManagementAcute Management
 Oxygen therapy
 GTN (½ sublingual tab)
 Aspirin 300mg
 IV morphine 2.5~5mg + IV metoclopramide 10mg
 Oxygen therapy
 GTN (½ sublingual tab)
 Aspirin 300mg
 IV morphine 2.5~5mg + IV metoclopramide 10mg

13. Hospital ManagementHospital Management
Aspirin, GTN, morphine, oxygen if not
already given
Monitor oximetry, BP, continuous ECG
12 lead ECG, IV access, cardiac
enzyme
Aspirin, GTN, morphine, oxygen if not
already given
Monitor oximetry, BP, continuous ECG
12 lead ECG, IV access, cardiac
enzyme

14. STEMISTEMI
 Reperfuse ASAP (within 12hrs of onset of sx – i.e. before MI is
complete):
 Antiplatelet therapy (aspirin and clopidogrel ± GPIIb/IIIa
inhibitor)
 Anticoagulation agent (unfractionated heparin or LMWH)
Immediate PCI or fibrinolytic therapy
– PCI has higher reperfusion rate and is better if pt present > 1hr
but thrombolysis is gold standard if pt arrive within an hour
 Reperfuse ASAP (within 12hrs of onset of sx – i.e. before MI is
complete):
 Antiplatelet therapy (aspirin and clopidogrel ± GPIIb/IIIa
inhibitor)
 Anticoagulation agent (unfractionated heparin or LMWH)
Immediate PCI or fibrinolytic therapy
– PCI has higher reperfusion rate and is better if pt present > 1hr
but thrombolysis is gold standard if pt arrive within an hour

15. STEMISTEMI
 Subsequent management (start during this hospital admission)
 Statins, aspirin and clopidogrel, ACEI (or ARB), β-blocker (if CI then
CCB)
 Nitrates PRN
 Cardiac rehabilitation
 Antiplatelet post stent
 Aspirin for life
 Clopidogrel for at least 6wks for metal stent
 Subsequent management (start during this hospital admission)
 Statins, aspirin and clopidogrel, ACEI (or ARB), β-blocker (if CI then
CCB)
 Nitrates PRN
 Cardiac rehabilitation
 Antiplatelet post stent
 Aspirin for life
 Clopidogrel for at least 6wks for metal stent

16. UA and NSTEMIUA and NSTEMI
 Stabilize acute coronary lesion
 Anti-platelet (aspirin and clopidogrel ± GPIIb/IIIa
inhibitor)
 Anti-thrombin (UFH or LMWH)
 Anti-ischaemia (β-blocker if CI then CCB, consider
nitrates, morphine)
 High risk – urgent angiography ± PCI
 Low risk – arrange stress tests
 Subsequent management (start during this hospital
admission)
 Statins, aspirin and clopidogrel, ACEI (or ARB), β-
blocker (if CI then CCB)
 Nitrates PRN
 Cardiac rehabilitation
 Stabilize acute coronary lesion
 Anti-platelet (aspirin and clopidogrel ± GPIIb/IIIa
inhibitor)
 Anti-thrombin (UFH or LMWH)
 Anti-ischaemia (β-blocker if CI then CCB, consider
nitrates, morphine)
 High risk – urgent angiography ± PCI
 Low risk – arrange stress tests
 Subsequent management (start during this hospital
admission)
 Statins, aspirin and clopidogrel, ACEI (or ARB), β-
blocker (if CI then CCB)
 Nitrates PRN
 Cardiac rehabilitation

17. Diet Physical activity Tabacco
Control
cardiovascular risk
What can I do to avoid
a myocardial infarction?