Confusion in the Cardiology Wing

1.​ Ischemia Hypoxia Stroke Cardiac arrest Heart attack Infarction 2.​ When ischemia reduces blood flow to the heart, it can lead to hypoxia, causing a heart attack. If the heart attack is severe enough, it can result in infarction of the heart tissue and potentially lead to cardiac arrest. Similarly, if ischemia occurs in the brain, it can cause a stroke, leading to brain cell death. 3.​ When the heart’s blood supply is severely reduced, restricted, or entirely cut off, the heart muscle experiences ischemia, leading to hypoxia. This deprives the heart tissue of oxygen and nutrients, causing damage. If the blood supply is not restored quickly, the affected heart tissue can undergo infarction, resulting in the death of cells. This can impair the heart’s ability to pump blood effectively and may lead to complications such as arrhythmias, heart failure, or cardiac arrest. 4.​ During a heart attack, cardiac blood flow is disrupted primarily by a blockage in the coronary arteries. This blockage is typically caused by a blood clot forming on top of plaque that has built up inside the artery, obstructing blood flow to the heart muscle. 5.​ The symptoms of a heart attack, as learned from the video include: chest pain or discomfort, shortness of breath (dyspnea), pain or discomfort in other areas of the upper body (arms, back, neck, jaw or stomach), lightheadedness, nausea and cold sweat. According to the American heart association, the three symptoms most common in women compared to men are: -​ Neck, jaw, shoulder, upper back or abdominal discomfort -​ Shortness of breath -​ Nausea or vomiting 6.​ A useful hypothesis for detecting a heart attack would involve tests that can assess heart muscle damage and blood flow. Possible test or procedures -​ Blood tests to detect elevated levels of cardiac enzymes (proteins) that are released into bloodstream when heart muscle is damaged -​ Electrocardiogram (ecg) to monitor the heart’s electrical activity and identify any abnormalities that suggest a heart attack or ischemia (reduced blood flow) -​ Imaging tests (e.g., echocardiogram or angiogram) to visualize the heart muscle and coronary arteries, assessing blood flow and identifying any blockages or areas of damage. 7.​ Test Justification Predicted results Troponin I and T Troponin I and T are highly specific cardiac biomarkers. They are released into the bloodstream following myocardial injury, indicating damage to the heart muscle.Their levels rise slowly but remain elevated for an extended period. Elevated levels of both Troponin I and T would be expected, confirming myocardial damage consistent with a MI. Levels would likely be significantly above the upper limit of normal. CK-MB Creatine Kinase-MB (CK-MB) is another cardiac enzyme released into the bloodstream after heart muscle damage. While less specific than troponin, it rises earlier than troponin, providing an early indication of possible MI. Elevated CK-MB levels would be expected, indicating myocardial damage. The rise would likely be earlier than the Troponin rise, but the elevation wouldn’t last long. ECG An electrocardiogram provides a real-time graphic representation of the electrical activity of the heart. It can reveal ST-segment elevation, indicating acute myocardial infarction, or other abnormalities suggestive of ischemia. The ECG would likely show ST-segment elevation in the leads corresponding to the affected area of the heart, confirming the diagnosis of myocardial infarction. Cardiac Enzymes (full panel) A comprehensive cardiac enzyme panel (beyond CK-MB) includes other enzymes like LDH and AST which can also indicate myocardial damage. While less specific than troponin, a broader panel may contribute to the overall picture. Elevated levels of some or all cardiac enzymes would support the diagnosis of MI, with varying degrees of elevation and time-courses. The panel’s utility is often in combination with the more specific troponin result. 8.​ A line graph should be drawn with the following characteristics: -​ X axis: time (hours 2-4, 24, 48 and 7 days) -​ Y axis: Relative concentration (arbitrary units; can be labeled as “concentration” or “units”) Three lines should be plotted: -​ Troponin I: starts low at hours 2-4, rises gradually to a peak around 24 hours, then plateaus for 48 hours and beyond (7 days). The peak level for Troponin I is the highest of the three. -​ Troponin T: similar pattern to troponin I, rising gradually, but its peak level is slightly lower and the plateau is maintained at slightly lower levels than Troponin I. -​ CK-MB: rises rapidly, peaking around hours 2-4, then declines quickly over the next 24 hours. At 48 hours and 7 days, CK-MB levels should be close to baseline. 9.​ Yes, Mr. Rodrigues' blood pressure and Pulse are higher than the typical range, and his oxygen saturation is lower than the typical range. 10.​Mr. Rodrigues’s ECG differs significantly from the typical ECG due to the absence of clear P waves, QRS complexes, and T waves, indicating an irregular heart rhythm. The ECG suggests a potential cardiac issue 11.​Yes cTnI, cTnT, CK-MB, and CK-MB2:CK-MB1 are all out of the typical range. These results suggest myocardial damage, consistent with a myocardial infarction. 12.​Angiogram: A procedure to visualize blood vessels using a catheter and dye injected into an artery. It’s helpful because it will pinpoint the location and severity of the blockage in MR. Rodgiguez’s coronary arteries, guiding treatment. Expected results: images showing the location and extent of the blockage, and the overall health of the coronary arteries. 13.​Typical symptoms of a heart attack in women include chest pain or discomfort, shortness of breath, nausea or vomiting, back or jaw pain, lightheadedness or dizziness,and unusual fatigue. Susans symptoms include shortness of breath, back and upper chest pain, nausea, and lightheadedness. So, yes the symptoms Susan mentioned do match up with the symptoms expected in a woman presenting with a heart attack. 14.​Mrs. Jones’ ECG appears normal based on visual inspection, but definitive diagnosis requires precise measurements. A comparison to Mr. Rodriguez’s ECG cannot be made without his ECG data. 15.​Blood pressure, pulse, CK-MB, CRP, cTnI, and cTnT are higher than normal. Oxygen saturation is lower than normal. 16.​CTnL (ng/ml): S. Jones: 0.05, comparison: Mr. Rodriguez’s value is much higher than Mrs. Jones’ cTnT (ng/ml): S.Jones: 0.016, comparison: Mr. Rodriguez’s value is much higher than Mrs. Jones’ CK-MB (IU/L): S. Jones: 28, comparison: Mr. Rodrigues’s value is higher than Mrs. Jones CK-MB2:CK-MB1: S. Jones: comparison: Mr. Rodriguez’s value is higher than Mrs. Jones. 17.​Takotsubo cardiomyopathy, also known as broken-heart syndrome, is a condition where sudden stress can cause a weakening of the left ventricle of the heart. The mechanism involves a surge of stress hormones, such as adrenaline, which can stun the heart muscle. Patients often present with chest pain and shortness of breath, similar to a heart attack. ECG changes may also mimic those of a heart attack. However, unlike a heart attack, there is usually no evidence of blocked coronary arteries in takotsubo cardiomyopathy. The key difference lies in the absence of a significant coronary artery blockage, which is typical in heart attacks. 18.​A coronary angiogram will differentiate between a heart attack and takotsubo cardiomyopathy. A coronary angiogram can visualize the coronary arteries and determine if there are any blockages. In takotsubo cardiomyopathy, the coronary arteries are typically clear, whereas, in a heart attack, one or more coronary arteries are blocked 19.​