Questions for Discussion:

  1. What are the major, independent risk factors for coronary artery disease? Answer
  2. What are secondary risk factors for coronary artery disease? Answer
  3. Given his history and PE, what do you estimate his likelihood of having significant coronary artery disease to be? Answer
  4. Using the Framingham data, what do you estimate his likelihood of a coronary event to be in the next ten years? Answer
  5. What additional studies or laboratory values would you like to further evaluate his condition? Answer

    You check a fasting lipid profile: TG 360, LDL 180, HDL 30, total chol 240
    His 12-lead EKG from clinic is on the following page. You speak with him again over the phone the next day to tell him the results as well as schedule a stress EKG. Nevertheless, the patient does not follow up with you.

    Approximately 6 months later, you pass by Mr. Jo as he is being wheeled to the coronary catheterization lab. He has O2 via face mask on, and the nurse tells you that he had crushing substernal chest pain and diaphoresis approximately 1 hour ago while shoveling snow. His initial cardiac enzymes are as follows: myoglobin 1200 (high), CK 160 (nl), and troponin .1 (<.1 is nl).

    (His 12-lead EKG is included in your hand-out).
     
  6. Define his clinical condition. What is the World Health Organization’s definition of an acute myocardial infarction? Answer
  7. What medical management should he receive immediately? Answer
  8. Describe the treatment rationale of thrombolytics and/or angioplasty in this scenario. Answer
  9. What are the indications for coronary artery bypass grafting? Answer

    Mr. JO is in the cath lab approximately 30 minutes after presenting to the ER. He had two stents placed in his left anterior descending artery. (Do any of the angiograms that were included correspond to his pathology? If so, which one?)

    You see him the following day. He is well. He slept OK overnight, and he is planning on being discharged.
     
  10. What medicines should he be placed on prior to discharge? Answer
  11. What are your target goals with these medicines? Answer
  12. What additional therapies should he receive? Answer
  13. Are there additional studies you want? Answer
     

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