Cardiovascular Case Study: Assessment and Management of a Patient with Acute Myocardial Infarction
Past medical/surgical history: Diabetes mellitus type 2.
Family history: He has a family history of premature coronary artery disease. His father died of acute myocardial infarction ( AMI ) at age 45. One brother died of AMI at age 49. Social history: He has smoked for 25 years but has reduced his smoking to 1 pack per day since his brother’s death two years ago. He has put on 25 pounds in the past two years and is generally sedentary.
Medications: Samuel was diagnosed with type 2 diabetes last year. He has been fairly well controlled with diet and Metformin, 500 mg daily. His last hemoglobin A1C was 7.4 two months ago.
Allergies: Latex.
OBJECTIVE
General: He is anxious and showing signs of chest pain as you enter the office room. He is slightly diaphoretic. He took an oral aspirin on the way to the office.
Vital s signs: BP: 192/96; P: 102; R: 22; T: 97.8. His SpO2 is 90%.
ECG: His stat ECG shows ST segment depression and T wave inversion in leads II and III.
Cardiovascular: His heart tones are muffled with an S3 gallop. His hands and feet are cool to touch. Radial pulses are 2 +. Pedal and posterior tibial pulses are 1 +. He has neck vein distention of 5 cm with the head of the bed at 90 degrees. He has no carotid bruits, heaves, or thrusts. His PMI is at the 5th ICS, left mid-clavicular line.
Respiratory: He has harsh bronchi in the upper lobes bilaterally and a nonproductive cough.
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Based on the described case scenario, please answer two of the following questions using at least one paragraph answering each question.