ANSWERS ON QUESTIONS

Main part

A 57-year-old man called a local therapist at home. Complains

intense pressing chest pains radiating to the left arm, left shoulder blade.

The above symptoms appeared about 2 hours ago after intense

physical activity. I took 2 tablets of Nitroglycerin on my own - without effect.

Previously, pains of this nature have never been bothered.

A history of hypertension over the past 10 years with

the maximum numbers of blood pressure 200/100 mm RT. Art. Regularly

I didn’t take any medications. Smokes 1 pack of cigarettes per day for 30 years.

Gas electric welder. Allergic reactions denied.

An objective examination: the skin is moist. In the lungs percussion

the sound is pulmonary, vesicular breathing, no wheezing. Heart sounds are weakened, rhythm

correct, blood pressure - 160/100 mm RT. Art., heart rate - 88 per minute. The abdomen is soft, painless.

Physiological administration is normal.

ECG recorded: sinus rhythm, ST segment elevation> 0.2 mV

Leads II, III, aVF. Transport access to the emergency hospital

cardiology, with the ability to conduct primary PCI - 30 minutes.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. What should be the tactics of patient management at the prehospital stage?

Justify your choice.

4. How much medical care should be provided to the patient at

prehospital stage?

5. Is there enough data to make a diagnosis? Justify your answer. At

If necessary, suggest additional research methods.

task 127 [K000934]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 59-year-old man was hospitalized in cardiology

dispensary from September 1 to September 14 about anterior Q-forming heart attack

myocardium from September 1. Arrived with complaints of intense pressing chest pain

with irradiation to the region of the left shoulder blade, shortness of breath arising after a stressful situation.

From the anamnesis it is known that in the last 2 years, blood pressure has periodically increased to

maximum figures 160/90 mm RT. Art. I didn’t receive drug therapy all the time,

Captopril 25 mg was occasionally taken. During exercise periodically

there was discomfort in the heart, shortness of breath. I did not seek medical help.

Smokes for more than 30 years at ½ pack of cigarettes per day. Family history: father died of a heart attack

myocardium at the age of 60. Works as a tower crane operator.

On admission, coronary angiography was performed, anterior occlusion was detected.

interventricular artery, performed PTCA and anterior endoprosthetics

interventricular artery.

In the analyzes: total cholesterol - 6.36 mmol / L, LDL - 3.69 mmol / L, HDL - 1.25

mmol / l, TG - 2.26 mmol / l, fasting glucose - 4.5.

ECHO-KG: left ventricular hypertrophy, an increase in the cavity of the left atrium.

Local hypokinesia of the lateral wall of the left ventricle. Mitral regurgitation 2 tbsp.,

tricuspid regurgitation 1 tbsp. Violation of the diastolic function of the left

ventricle (VE / VA <1.0). PV - 48%.

The period of inpatient treatment was uneventful, after discharge the patient

sent to a specialized cardiorehabilitation hospital, where he was until

September 30th.

Bicycle ergometry results: submaximal heart rate - 137 beats per minute

achieved with a load of 100 watts.

Test results with a 6-minute walk: 412 meters covered in 6 minutes.

September 30 was at a reception in the clinic at the place of residence. Heart pain is not

disturbed by short walking shortness of breath.

Constantly taking Aspirin 100 mg / day, Clopidogrel 75 mg / day, Atorvastatin

40 mg / day, Bisoprolol 2.5 mg / day, Lisinopril 5 mg 2 times a day.

On examination: satisfactory condition. BMI - 37 kg / m 2 . Skin integument

clean, normal color. In the lungs, vesicular breathing, no wheezing. NPV - 16 in

a minute. Heart sounds are weakened, the rhythm is correct. Heart rate - 70 beats per minute, blood pressure -

150/100 mmHg Art. The abdomen is soft, painless on palpation in all departments. Liver

and the spleen is not enlarged. No swelling. There are no dysuric disorders. Symptom

lumbar effusion negative on both sides.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Develop a rehabilitation program at the outpatient stage.

4. Evaluate the data of laboratory tests and objective examination of the patient,

Correct drug therapy.

5. Indicate the period of temporary disability. Develop a dispensary plan

observations.

Situational task 128 [K000935]