CASE STUDY 1: ACUTE ANTEROLATERAL MYOCARDIAL
INFARCTION
Present Illness
Patient A is white, 60 years of age, and works as a cab driver. While driving home after work, he
develops an aching in his chest and slight, regular palpitations. The ache is still present when he
goes to bed, when he wakes several times during the night, and when he gets up in the morning,
seven hours after retiring. He drinks some soda water, but when the aching does not improve, he
decides to go to the emergency department.
At the hospital, Patient A complains of chest pain accompanied by diaphoresis, slight shortness of
breath, and nausea. Relief of pain is obtained with IV morphine sulfate. When the patient is admitted
to the critical care unit (CCU), his symptoms are generally unremarkable except for recurrent pain.
Medical History
Patient A experienced the usual childhood illnesses without rheumatic fever. As an adult, he has a
history of hypertension (documented on discharge from the Army at 45 years of age and when
hospitalized two years ago) that has not been treated. Past surgery includes tonsillectomy and
adenoidectomy as a child. A cataract was removed from his right eye two years ago.
Patient A's father died of an MI at 55 years of age. His mother is alive and well, although the patient
does not know her age. Two brothers, 65 and 58 years of age, are alive and well. The patient lives
alone and works approximately 72 hours per week. He has been married and divorced twice; the last
divorce was four years ago. He has no children.
Assessment and Diagnosis
Upon admittance to the CCU, a full physical exam is conducted (Table 4). An ECG is done and
shows ST elevation. Several laboratory tests are ordered, with the following results:
Serum cardiac enzymes:
oCK: 164 IU/L
oLDH: 219 IU/L
Serum glutamic-oxaloacetic transaminase (SGOT): 31 IU/L
CBC: Within normal limits
Electrolytes: Within normal limits
Urinalysis: Within normal limits
PATIENT A'S PHYSICAL EXAM RESULTS
Parameter Findings
General
appearance
White male in mild distress, appears his stated age
Height: 5 feet 9 inches (176 cm)
Weight: 195 pounds (88.5 kg)
Head and eyes Normocephalic
