Free Online Assignment; Activity 2 Case Study Example
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The probable diagnosis for this assignment is Myocardial Infarction (MI). The diagnosis of MI can be made based on various testing modalities and immediate intervention is then warranted.
The patient typically presents with severe radiating type chest pain and the first non-invasive and sensitive testing modality used is electrocardiogram (EKG). According to Papadakis and McPhee (2015, p. 367), classical EKG findings in an ischemic cardiac event are elevation of ST-segment, Q wave appearance and inversion of T wave. The underlying mechanism is explained by Barrett, Brooks, Boitano and Barman (2010, p. 502) that infarcted area has greater membrane potential than the normal area making it an area of delayed depolarization. The hallmark ST segment elevation is fundamentally a TQ segment depression that is recorded as such on the EKG.
Later, cardiac enzymes should be measured in the blood and correlation should be done. Cardiac muscles produce certain cardiac enzymes which are elevated markedly during an ischemic event. Creatine Kinase –MB subunit (CK-MB), troponin I and T. Papadkis and McPhee (2015, p. 367) suggests that troponins are more sensitive and specific for the diagnosis of an MI. their levels start to peak within 4 to 6 hours and may persist elevated to as long as 5 to 7 days or even longer. CK-MB, however, elevates within 4 to 6 hours but becomes normalized within 24 hours. So, late presenting MI can be missed if CK-MB is measured only for diagnostic purposes. According to Ferrier and Harvey (2014, p. 130), cardiac troponin I (cTnI) coupled with clinical presentation and echocardiography is the gold standard for diagnosis of MI.
Echocardiography is also a commonly used radiologic investigation that can assist in diagnosis and therapeutic decision for a particular case. The infarcted area becomes immobile and rigid and the infarction also leads to valvular incompetency. Echocardiography is the best method to assess wall motion defect or valvular regurgitation. (Papadakis and McPhee, 2015, p. 367)
Barrett, K., Brooks, H., Boitano, S., & Barman, S., 2010. Ganong’s Review of Medical Physiology (Lange Medical Books). 23rd Edition. McGraw-Hill Education
Ferrier, D.R., Harvey, R.A., 2014. Lippincott’s Illustrated Reviews Biochemistry; 2014 (Wolters Kluwer Health). 6th Edition. Lippincott Williams & Wilkins.
Papadakis, M.A., McPhee, S.J., 2015. Current Medical Diagnosis & Treatment; 2015 (Lange Medical Books). 54th Edition. McGraw-Hill Education.
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