Cardiovascular Case Study
Mr. Smith is a 56-year-old Caucasian man who is being evaluated in the emergency room with progressively worsening chest pain that began 2 hours ago. The patient describes the pain as pressure in the center of his chest. He rates his pain 7/10. He reports the pain is now radiating down his left arm and through to his back, he is diaphoretic, and complaining of shortness of breath. He denies nausea or vomiting.

Mr. Smith reports no previous history of chest pain or pressure. He smoked one pack of cigarettes daily for 13 years but quit smoking last year. He denies a family history of heart disease. Upon initial examination he did not have jugular venous distension, no carotid bruits, normal S1 and S2 with an S3 present. No S4 or murmurs auscultated. Lung sounds clear to auscultation bilaterally, bowel sounds normal, all pulses palpable 2+/4, no edema present.

Diagnostic data:
BP: 165/98 mmHG
HR: 96 bpm
RR: 30 breaths/min
Temp: 37 C
SaO2: 96% with 2L/min O2 per nasal cannula
Wt:100 kg

A 12-lead ECG was performed in the emergency room showed:

Normal Sinus Rhythm (NSR) with frequent premature ventricular contractions. ST segment elevation in Leads 1, aVL, and V2 through V6 (3mm). ST segment depression in Leads III and aVF. Q waves in V2 through V4.

The chest X-ray revealed slight cardiomegaly with mild congestive heart failure.

An echocardiogram reveals an ejection fraction of 30% and mild mitral valve regurgitation.

Mr. Smith’s cardiac enzyme lab values were as follows:

Admission 2000 Admission 2400 Day 1 0400

|CK (U/L) |255 |7400 |4998 |
| | | | |
|CK-MB (%) |11 |>300