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Cardiovascular Case Study of Mr. T

Mar 4, 2025

Cardiovascular Alterations: Case Study of Mr. T

Patient Background

  • Patient: Mr. T
  • Age: 54-year-old
  • Ethnicity: Asian male
  • Condition: Unstable angina and inferior wall STEMI
  • History: Mild angina for 2 years, controlled by sublingual nitroglycerin

Hospital Admission

  • Transport: By EMS to emergency department
  • Reason for Admission: Increased frequency of pain episodes and pain at rest
  • Initial Treatment: Thrombolytics (10 units slow IV push, repeated after 30 minutes)

Treatment Approach

  • Reason for Thrombolytics: Delay in PCI if transported, PCI should occur within 90 minutes from initial contact
  • Considerations: Start large bore IVs and perform blood draws before thrombolytics to minimize bleeding risk

Potential Complications

  • Inferior MI Complications: First or second degree heart block, right ventricular infarction
  • Reperfusion Syndrome: Bradycardia, hypotension due to reflex

Acute Event

  • Symptoms: Cardiac rhythm dropped to 40 bpm, dizziness, and breathlessness
  • Potential Cause: Reperfusion syndrome causing increased vagal tone
  • Immediate Actions: Quick vitals check, possible atropine for bradycardia, and fluids for vasodilation effect

Discharge Planning

  • Medications: Likely beta blockers, ACE inhibitors
  • Psychosocial Support: Address guilt and stress of being the primary breadwinner, provide support for the son

Surgical Interventions

Coronary Artery Bypass Graft Surgery (CABG)

  • Procedure: Rerouting blood flow beyond occluded lesions
  • Grafts Used: Saphenous vein, internal mammary artery, or radial artery
  • Indications: Refractory angina, left main occlusion, triple vessel disease
  • Risks: Mortality linked to left ventricular dysfunction, emergency surgery, advanced age

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

  • Approach: Minimizes trauma by avoiding full sternotomy
  • Techniques: Port access coronary artery bypass

Complications of Cardiac Surgery

  • Cardiac: Low cardiac output, renal impairment, arrhythmias
  • Infection: Mediastinal infection risks
  • Post-operative Care: Ventilator weaning, managing pacing wires, chest tubes

Transmyocardial Revascularization (TMR)

  • Method: Laser-created channels to improve myocardial perfusion
  • Candidates: Those unsuitable for CABG

Management Strategies

Persistent Dysrhythmias

  • Radiofrequency Catheter Ablation: Targeting SVT circuits
  • Pacemakers: Temporary and permanent options
  • ICDs: For high-risk lethality rhythms, patient education crucial

Heart Failure Management

  • Medications: Diuretics, ACE inhibitors, beta blockers
  • Mechanical Support Devices: Intraaortic balloon pumps, ventricular assist devices (VADs)

Discharge and Lifestyle

  • Follow-up: Surgeon and cardiologist
  • Lifestyle Changes: Diet, activity modification, incision care

Inflammatory Heart Diseases

Pericarditis

  • Causes: MI, infection, radiation, connective tissue diseases
  • Symptoms: Sharp chest pain, friction rub
  • Treatment: Antimicrobials, pericardial drainage if necessary

Infective Endocarditis

  • Causes: Microbial adherence to endocardium
  • Symptoms: Fever, new heart murmurs, Janeway lesions
  • Treatment: IV antibiotics, possible valve surgery

Genetic Disorders

Marfan Syndrome

  • Features: Connective tissue disorder, cardiovascular and ocular complications
  • Management: Tailored to specific manifestations

This concludes the summary of the lecture on cardiovascular alterations focusing on the case of Mr. T and related cardiovascular interventions and complications.

Full transcript