Chief Complaint With Question & Answer Guide (With Explanation)

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Use appropriate theories and support your answer with clear reasoning.

Key Explanation

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Original Question

CHIEF COMPLAINT SOB with diaphoresis and EKG en route to hospital showing 3-4 mm ST segment elevations in V4 through V6 with T-wave inversion in V4 through V6 and an inferior wall MI of indeterminate age. HISTORY OF PRESENT ILLNESS This is a 71-year-old female with a long-standing history of heart problems since the age of 48 who was admitted to the coronary care unit to rule out acute lateral wall myocardial infarction. She began developing chest pain, shortness of breath and diaphoresis about 5 days ago and was brought by ambulance, where an EKG showed ST elevation and T-wave inversion in V4 through V6 and an inferior wall MI of indeterminate age. She was started on nitrates and diltiazem with relief of her symptoms. DATABASE The chest x-ray revealed pulmonary edema with a widened mediastinum consistent with a tortuous aorta, unable to rule out a dissection. A chest CT scan revealed evidence of dissection. She was transferred to the coronary care unit for hemodynamic monitoring and possible coronary catheterization. IMPRESSION 1. Coronary artery disease with evidence of new inferolateral wall myocardial infarction on electrocardiogram. PLAN We will restart nitrates and diltiazem and consider captopril for afterload reduction. A gated nuclear study is planned to look for focal areas of akinesia. We will continue her Lasix therapy as well. E/M: _____

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