case study

Personal Information

Name: Mrs. Paula Johnson

Age: 65 years old

Gender: Female

Description

Mrs. Paula Johnson is a 65-year-old white woman with a previous history of a sedentary lifestyle, hypertension, hypercholesterolemia, and diabetes mellitus type II. She is a heavy smoker since she was 20 years old. She was brought to the emergency room because her family found her unresponsive on the floor. She was diaphoretic. Her family thought she had her diabetes decompensated. Mrs. Johnson’s daughter indicated her mother was complaining of nausea and epigastric pain the day before. Also, her blood pressure was high.

On the physical examination we found:

Remarkable Signs on Physical Exam by Regions

Chest: Palpitation
Remarkable Signs on Physical Exam by Systems

Integumentary system: Profuse diaphoresis, coldness, and pallor
Respiratory system: Tachypnea
Cardiovascular system: Weak pulse, tachycardia, and hypotension
Nervous system: Unconsciousness. No other neurologic signs.
Lab Tests

Complete blood count (CBC)
Cardiac enzymes
Glucose level
Lipid panel
EKG
Cardiac catheterization
Diagnosis

Silent myocardial infarction
Other Diagnoses

Essential hypertension
Dyslipidemia
Diabetes mellitus
Supporting Material

Mrs. Johnson has been diagnosed with silent myocardial infarction. As we learned last module, the first step in pathophysiology is observation of noticeable changes, but what do we do when the patient does not outwardly experience symptoms? Chest pain is a scary symptom that usually alerts the physician and patient. However, if the patient or the physician is not alerted, the medical practitioner has to dig deeper to understand the cause or set of causes that contribute to the condition.

Instructions

In at least 375 words, or 1.5 double-spaced pages, prepare a case report that addresses the following:

Based on the case study provided, respond to the following questions:
Mention the symptoms and signs you found in this patient.
Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis?
What is a silent myocardial infarction, and why did it happen to this patient?
What results do you expect to find in the tests ordered?
What are some differential diagnoses?
What are some complications of myocardial infarction?
The patient suffers from silent myocardial infarction, but there are other types of heart diseases. Consider these questions:
Describe the heart valvular disorders and how they can produce cardiac failure.
What is endocarditis, and what are the most common causes?
How many types of shocks are there? Explain them.
As a lifetime smoker, the patient is at risk of several respiratory disorders. Consider these questions:
What is COPD? What are the three most common diseases that produce a COPD? What are their causes?
What is asthma? Explain the origin of its symptoms.
What is a pneumothorax? What are its symptoms and signs, and what are its causes?
All references must be cited using APA Style format.

ANSWER

Case Study: Silent Myocardial Infarction

Case Study: Silent Myocardial Infarction

1. Based on the case study provided, respond to the following questions:

Mention the symptoms and signs you found in this patient.

The patient’s family mentioned that she had been complaining of nausea and epigastric pain. Also, the patient had high blood pressure. Tachypnea in the respiratory system, weak pulse, hypotension, tachycardia, unconsciousness, coldness, pallor, and profuse diaphoresis were also observed upon examination.

Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis?

The patient has a history of a sedentary lifestyle, hypercholesterolemia, hypertension, and diabetes mellitus type II. She is also a heavy smoker who has been smoking since she was 20 years old.

What is a silent myocardial infarction, and why did it happen to this patient?

Silent myocardial infarction (SMI) relates to the absence of symptoms that are associated with myocardial ischemia. Silent myocardial ischemia is the presence of objective evidence of myocardial ischemia in the absence of chest discomfort or other anginal equivalent symptoms such as diaphoresis or nausea (Valensi et al., 2011). The risk factors of SMI include a family history of heart disease, heavy smoking, age, systemic blood pressure, high blood cholesterol, diabetes, and being overweight. The SMI in this patient may have happened because of the heavy smoking.

What results do you expect to find in the tests ordered?

• Lipid profile: within the first 24 hours of the SMI. Elevated serum TGs and TC, decreased HDL-C and elevated LDL-C.
• Cardiac enzyme: increased myocardial muscle creatine kinase (CK-MB).
• EKG: large-peaked T waves, ST elevation, negative T waves, then the development of pathologic Q waves.

What are some differential diagnoses?

• Respiratory diagnoses: pneumothorax and pneumonia.
• Cardiovascular diagnoses: stable angina, a different form of ACS (NSTEMI or unstable angina), myocarditis, acute pericarditis, aortic stenosis, pulmonary embolism, and aortic dissection.

What are some complications of myocardial infarction?

A life-threatening complication is a cardiogenic shock, during which hypotension will occur from the low cardiac output (Valensi et al., 2011). A left ventricular aneurysm can also occur.

1. The patient suffers from silent myocardial infarction, but there are other types of heart diseases. Consider these questions:

Describe the heart valvular disorders and how they can produce cardiac failure.

When one has valvular heart disease, the heart valves become too narrow and hardened (stenotic) to open fully or close completely (incompetent). Stenotic valves force blood to back up in the adjacent heart chambers, while incompetent valves allow blood to leak back into the chambers they previously exited. Narrowed valve openings make the heart work harder to pump blood through them, which can lead to heart failure and other cardiac problems.

What is endocarditis, and what are the most common causes?

Endocarditis is an infection of the endocardium – the inner lining of the heart chambers and valves. It is caused by bacteria in the bloodstream multiplying and spreading across the endocardium (Kestler et al., 2017).

How many types of shocks are there? Explain them.

• Cardiogenic shock – shock due to heart problems.
• Neurogenic shock – shock caused by damage to the nervous system.
• Hypovolemic shock – shock caused by too little blood volume.
• Septic shock – shock caused by infections.
• Anaphylactic shock – shock caused by an allergic reaction.

1. As a lifetime smoker, the patient is at risk of several respiratory disorders. Consider these questions:

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a disease of the lungs characterized by chronic obstruction of lung airflow, which interferes with normal breathing and is not completely reversible (Mayo Clinic, 2020). “chronic bronchitis” and “emphysema” are common terms that are included in COPD diagnosis.

What are the most common diseases that produce a COPD? What are their causes?

The common diseases that produce COPD are emphysema and chronic bronchitis. The main cause of these diseases is long-term exposure to irritating gases and particulate matter, including cigarette smoke (Mayo Clinic, 2020). Long-term smoking is thought to be responsible for approximately 9 in every 10 cases.

What is asthma? Explain the origin of its symptoms.

Asthma is a chronic disorder of the conducting airways. It is caused by an immunological reaction characterized by episodic bronchoconstriction due to increased airway sensitivity to a variety of stimuli, increased mucus secretion, and inflammation of the bronchial walls (Mayo Clinic, 2020). Its symptoms include recurring episodes of wheezing, coughing, chest tightness, and shortness of breath.

What is a pneumothorax? What are its symptoms and signs, and what are its causes?

A pneumothorax is a collapsed lung. It occurs when air leaks into the space between the lungs and the chest wall (Noppen & De Keukeleire, 2008). The air pushes on the outside of the lungs, making them collapse. Pneumothorax can be a full lung collapse or a collapse of a portion of a lung. Its signs and symptoms include shortness of breath, chest pain (more severe on one side of the chest), sharp pain when inhaling, pressure in the chest that gets worse over time, blue discoloration of the skin or lips, increased heart rate, and rapid breathing (Noppen & De Keukeleire, 2008).

References

Kestler, M., Muñoz, P., Marín, M., Goenaga, M. A., Viedma, P. I., de Alarcón, A., … & Costas, C. (2017). Endocarditis caused by anaerobic bacteria. Anaerobe, 47, 33-38.

Mayo Clinic. (2020, April 15). COPD. https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679.

Mayo Clinic. (2020). Asthma. https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653.

Noppen, M., & De Keukeleire, T. (2008). Pneumothorax. Respiration, 76(2), 121-127.

Valensi, P., Lorgis, L., & Cottin, Y. (2011). Prevalence, incidence, predictive factors, and prognosis of silent myocardial infarction: a review of the literature. Archives of cardiovascular diseases, 104(3), 178-188.