Myocardial Ischemia Case Study

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Myocardial Ischemia
Introduction
A 55-year old, male truck driver, presents with crushing central chest pain which has radiated to his neck and occurred on rest. On arrival, the patient was pale and clammy, demonstrated shortness of breath. his pulse rate was 120 beats per minute, blood pressure 150/70 and his oxygen saturation level was 96%. The patient presented with chest pain due to myocardial ischaemia. Myocardial ischaemia is a disease caused by a coronary artery obstruction which reduces or cuts off the blood supply to the heart muscle tissue or myocardium and causes tissue ischaemia. 1 When myocardial ischaemia is prolonged it can cause acute coronary syndromes such as unstable angina, ST-elevation myocardial infarction and non-ST elevation
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He is short of breath, pale and has clammy skin. His pulse on arrival is 120 beats per minute, blood pressure is 150/70 and his oxygen saturation level is 96% on room air. Patients with myocardial ischemia and other acute coronary syndromes such as this patient in the case study, typically present with chest pain which can radiate to the arms, back, jaw and neck and is often described as either heavy, squeezing, crushing or tight pain in the chest. 2 The onset and severity of pain suggest that the patient’s myocardial ischaemia may have culminated or resulted in other associated acute coronary syndromes such as unstable angina or an acute myocardial infarction which is typical of crushing chest pain as the pain associated with myocardial infarction tends to be more severe and lasts longer. 1 The patient presents with other typical signs and symptoms of acute coronary syndromes such as being pale and clammy, having shortness of breath, an increased pulse rate (tachycardia), increased blood pressure (hypertension) and reduced oxygen saturation levels. 6 The crushing or severe pain the patient described can cause anxiety which can affect clinical signs and symptoms resulting in an increased heart rate or tachycardia, increased blood pressure and an increase in the patient’s respiratory rate observed as shortness of breath. The reduced oxygen …show more content…
1 Different mechanisms can impair blood flow through the coronary arteries which can cause myocardial ischemia. The most common cause of myocardial ischaemia are atherosclerotic plaques which are formed by an accumulation of cholesterol and other fatty materials in the vessel wall which harden and cause the opening of the vessel to narrow, impairing blood flow to the heart 8. Atherosclerotic plaques can also rupture causing platelets to become stickier and clots to form (thrombi) which can obstruct or occlude coronary arteries, thereby cutting off or reducing blood supply to the heart, causing ischaemia. 1,9 If the obstruction in the vessel cannot be cleared rapidly, blood supply does not keep up with demand and perfusion is not restored, myocardial ischaemia will progress into myocardial infarction 10 which causes injury to heart tissue and death of heart cells. Those at risk of developing myocardial ischaemia include individuals with a history of vascular disease such as atherosclerosis, heart attack or stroke, people over the age of 40, individuals with high blood pressure, high cholesterol, overweight. obesity, physical inactivity, alcohol and smoking. 5,6 It is important to understand the aetiology and pathophysiology of myocardial ischaemia and how this can rapidly progress

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