5.14 Learning Activities

Case Study: Chest Pain 

Patient Information:

• Name: Mrs. Fatima Khan
• Age: 58
• Gender: Female
• Ethnicity: Pakistani
• Medical History: Hypertension, Hyperlipidemia, Type 2 Diabetes Mellitus
• Allergies: None reported
• Current Medications: Lisinopril 10 mg daily, Metformin 1000 mg twice daily, Atorvastatin 40 mg daily

Mrs. Fatima Khan presents to the emergency department complaining of severe chest pain that started approximately 30 minutes ago. She describes the pain as a crushing sensation located in the center of her chest, radiating to her left arm. She rates the pain as 9/10 on the pain scale and reports associated symptoms of diaphoresis, nausea, and shortness of breath.

Assessment Findings:

Vital Signs: BP 180/100mmHg, HR 110 bpm, RR 24 bpm, O2 sat 92% on Room Air, Temperature 37.0 C (98.6 F).

Physical Examination: Patient is diaphoretic with a S3 gallop, shallow respirations and audible crackles bilaterally.  Skin is cool, clammy, and pale.

Laboratory Values:

• • Troponin: Elevated (TnI > 0.04 ng/mL)
  • CK-MB: Elevated
  • ECG: ST-segment elevation in leads II, III, aVF, and V1-V6
  • Blood Glucose: 220 mg/dL
  • Total Cholesterol: 240 mg/dL

Diagnostic Tests: Echocardiogram: Left ventricular dysfunction with decreased ejection fraction (EF 30%)

1. What is the significance of elevated troponin levels in a patient with suspected MI?
2. How do elevated CK-MB levels contribute to the diagnosis of MI, and how do they differ from troponin levels in timing and specificity?
3. Why is it important to monitor blood glucose levels in a patient with acute MI, and what impact can elevated levels have on the patient’s prognosis?
4. Describe the role of total cholesterol levels in the assessment of cardiovascular risk and their relevance in the management of MI.