Review cases 14-Apr-09

1 SA is a 47 years old male who developed crushing substernal chest pain around 10 pm, he didn’t went to the hospital, in the morning when he went to the ER his chest pain was gone, In ER he was diagnosed with acute myocardial infarction, his past medical history is significant for hypertension and type II diabetes, his HR is 90 BPM, BP 150/94 mmHg. Which therapies should SA receive in the ER that are expected to reduce mortality in the acute MI? a)Aspirin b)Aspirin, heparin c)Aspirin, metoprolol d)Aspirin, metoprolol, nitoglycerin

2 R.M. is a 50 years old female with a 10 years history of hypertension who is ready to discharged from a hospital stay for an acute anterior wall ST segment elevation MI. during the course of her hospitalization she received alteplase (fibrinolytic) in the emergency department and had a resolution of her chest pain with no further recurrence during hospitalization. Five days post MI an echocardiogram was done that showed a left ventricular ejection fraction of 30%, her BP is 140/85 mmHg and her HR 76 BPM, her total cholesterol is 215 mg/dl (goal below 100 mg/dl). she is not complaining of any chest pain anymore, Which medication should be included in her discharged regimen a)Aspirin b)Aspirin, metoprolol, lisinopril c)Aspirin, metoprolol, lisinopril, simvastatin d)Aspirin, metoprolol, lisinopril, simvastatin, isosorbid dinitrate

3 M.N. is a 49 years old woman with a history of chronic stable angina, Hypertension and arthritis. She had a myocardial infarction 2 years ago that was treated successfully with thrombolytics. During this follow up visit, she states that her chest pain episodes are under control and occur infrequently. She has been able to resume all of her normal daily activities. She currently is complaint with her diet and exercise 3-4 times/ week. Current drugs include aspirin 81 mg /day, metoprolol 50 mg BID, amlodipine 10 mg /day, and SL nitroglycerin. Today her BP is 134/84 mmHg and her HR is 52 beats /minutes. Which one of the following is an appropriate recommendation to improve her survival? a)No changes are needed, her HR, BP and chest pain are under control b)Start lisinopril 2.5 mg /day c)Increase metoprolol to 100 mg BID d)Increase aspirin to 325 mg /day

4 LW is a 64 years old woman with significant coronary disease history, having two myocardial infarction and three stent placement. Her ejection fraction is preserved at >60 %. Her current medication after PCI (percutanous intervention) includes aspirin 81 mg /day, simvastatin 40 mg /day, enalapril 10 mg /day, and metoprolol 50 mg BID. Her BP is 132/80 mmHg and her HR is 72 BPM, what do you recommend to improve her state a)Continue current medication add Clopidogril 300 mg/day b)Continue current medication add Clopidogril 75 mg /day c)Stop aspirin and start Clopidogril 300 mg/day d)Stop aspirin and start Clopidogril 75 mg/day a)

5 67-year-old man has a history of hypertension, chronic stable angina, and type 2 diabetes mellitus. His current drugs are metoprolol XL 100 mg/day, isosorbide mononitrate 60 mg 2 times/day, nitroglycerin sublingual as needed, metformin 850 mg 2 times/day, simvstatin 20 mg/day, and aspirin 81 mg/day. His BP is 154/84 mm Hg, and his heart rate is 60 beats/minute. Laboratory values are all normal and his hemoglobin A1c is 8 mg/dL. He still has chest pain, which is relieved with sublingual nitroglycerin tablets. Which one of the following is the most appropriate therapy to reduce this patient’s risk for CV events? a)Add lisinopril b)Replace metoprolol with diltiazem c)Replace metoprolol with atenolol. d) Add lisinoprill and amlodipine