Case #1: AMI PRESENTED BY AMI ALANIZ

Present Illness  53 year old white male  chest discomfort while playing tennis  became crushing sensation in sternal area and spread to jaw  tennis partner called 911  arrived at hospital within 30 minutes of onset chest pain

Medical Treatment So Far o nasal cannulae o 5% dextrose in water o 325 mg aspirin o 2 mg intravenous (IV) morphine o sublingual nitroglycerin (SL NTG) tablets o Experienced 0 effects

Predisposed?

Medical History  ulcerative colitis – 22 years  hypertension – 12 years  type 2 diabetes mellitus – 5 years  post acute myocardial infarction  5 years ago  chronic stable angina – 4 years  benign prostatic hyperplasia  hypertriglyceridemia  adenomatous colonic polyops

Histology: Athersclerotic Plaque Cross Section

Femoral Atherosclerotic Artery

Percutaneous Transluminal Coronary Angioplasty

Familial & Social History  father died from myocardial infarction at age 55  also had diabetes mellitus  sister, age 52, no reported health issues  brother, age 44, with hypertension  history of cigarette smoking  recurring chest pain with physical activity for the past month

Medications  Amlodipine: 5 mg every morning  Glyburide: 10 mg every morning, 5 mg every night  Aspirin regimen: 325 mg daily  Gemfibrozil: 600 mg twice daily  sulfasalazine: 1.5 grams twice a day  terazosin: 1 mg before bed

In the Hospital

Patient Chart  High Blood Pressure: 160/98  Temperature: 98.2  Height: 5’ 10 ½”  Weight: 184  tachycardia with an occasional premature beat  bibasilar inspiratory crackles with auscultation  bilateral mild pulmonary edema

Pulmonary Edema

Normal vs Edema

Two Days Into His Stay…  stable until he began to experience chest pain again  “emergency angiography revealed a 95% obstruction in the left anterior descending coronary artery”  consistent with completed acute myocardial infarction  percutaneous transluminal coronary angioplasty was successfully performed  successful placement of stent

Happy Ending? o gradually ambulated o physical activity slowly increased o discharged eight days post-AMI