Pagana: Mosby\u2019s Manual of Diagnostic and Laboratory Tests, 6th Edition
\nAngina
\nCase Studies
\nThe patient was a 48-year-old man admitted to the coronary care unit complaining of substernal
\nchest pain. During the 4 months preceding admission, he noted chest pain radiating to his neck
\nand jaw during exercise or emotional upsets. The pain dissipated when he discontinued the
\nactivity or relaxed. The results of his physical examination were essentially normal except for a
\nsystolic murmur heard best at the apex of the precordium and radiating into the left axilla.
\nStudies Results
\nRoutine laboratory work Within normal limits (WNL)
\nCardiac enzyme studies
\nCreatine phosphokinase
\n(CPK), p. 167
\n235 units\/L (normal: 55\u2013170 units\/L)
\nCPK-MB, p. 171 12 ng\/mL (normal: 0\u20133 ng\/mL)
\nLactic dehydrogenase (LDH), p. 293 120 units\/L (normal: 90\u2013200 units\/L)
\nSerum aspartate aminotransferase
\n(AST), p. 107
\n24 International units\/L (normal: 5\u201340 International
\nunits\/L)
\nTroponins, p. 451 18 ng\/mL
\nEchocardiography, p. 820 Hypokinetic portion of the lateral left ventricle
\nElectrocardiography (EKG), p. 485 Evidence of left ventricular hypertrophy
\nChest x-ray study, p. 956 WNL
\nExercise stress test, p. 481 Positive: pain reproduced, ST segment depression noted
\non EKG (normal: negative)
\nEchocardiography, p. 820 Normal ventricular wall motion
\nTransesophageal echocardiography
\n(TEE), p. 840
\nMitral regurgitation, dilated left atrium
\nLipoproteins, p. 304
\nHDL 29 mg\/dL (normal: >45 mg\/dL)
\nLDL 189 mg\/dL (normal: 60\u2013180 mg\/dL)
\nVLDL 12 mg\/dL (normal: 7\u201332 mg\/dL)
\nHomocysteine, p. 269 16 \uf06dmol\/L
\nC-reactive protein (CRP), p. 165 22 mg\/dL
\nCardiac catheterization, p. 950 All WNL except:
\nPressures
\nLeft ventricular systolic
\npressure
\n140 mm Hg (normal: 90\u2013140 mm Hg)
\nAortic systolic pressure 130 mm Hg (normal: 90\u2013140 mm Hg)
\nVentricular-aortic pressure
\ngradient
\n5 mm Hg (normal: 0)
\nLeft ventricular function
\nCardiac output 3.5 L\/min (normal: 3\u20136 L\/min)
\nCase Studies
\nCopyright \u00a9 2018 by Elsevier Inc. All rights reserved.
\n2
\nEnd diastolic volume (EDV) 60 mL\/m2
\n(normal: 50\u201390 mL\/m2
\n)
\nEnd systolic volume (ESV) 22 mL\/m2
\n(normal: 25 mL\/m2
\n)
\nStroke volume (SV) 38 mL\/m2
\n(SV = EDV \u2212 ESV)
\nEjection fraction 0.63 (normal: 0.67 \u00b1 0.07)
\nCineventriculography Mitral regurgitation present, normal muscle function
\n(normal: normal ventricle)
\nAnalysis of O2 gas content, p. 98 No shunting (normal: no shunting)
\nCoronary angiography (coronary
\ncineangiography), p. 950
\n90% narrowing of left coronary artery (normal: no
\nnarrowing)
\nCardiac radionuclear scanning, p.
\n733
\nScans normal showed localized area of decreased
\nperfusion and poor muscle function in the myocardium
\nduring exercise
\nCholesterol, p. 138 502 mg\/dL (normal: <200 mg\/dL)
\nTriglycerides, p. 447 198 mg\/dL (normal: 40\u2013150 mg\/dL)
\nDiagnostic Analysis
\nCardiac radionuclear scanning, EKG, and studies ruled out the possibility of MI. Troponins and
\nserial cardiac enzyme indicated cardiac ischemia. Stress testing and a nucleotide scan indicated
\nthat the patient was having exercise-related myocardial ischemia (angina). Echocardiography
\nindicated that the heart muscle at the site of ischemia was functioning poorly. Transesophageal
\nechocardiography indicated that the patient had mitral regurgitation. Cardiac catheterization with
\ncineventriculography demonstrated near-normal ventricular function, and coronary angiography
\nindicated significant narrowing of the left coronary artery. Mitral regurgitation was also seen.
\nThe patient\u2019s angina was then thought to be caused by the coronary artery disease. Open heart
\nsurgery was performed. The patient’s mitral valve was replaced with a prosthesis, and an
\naortocoronary artery bypass graft was performed. Postoperatively, he had a large pericardial
\neffusion. This diminished his heart function. He underwent pericardiocentesis, and his function
\nimproved. Because his serum lipids study showed type IIa hyperlipidemia, a low-cholesterol diet
\nand cholesterol-lowering agents were prescribed. The other cardiac risk factors did indicate
\nincreased risk for coronary heart disease. Six months later he was asymptomatic and jogging 3
\nmiles per day.
\nCritical Thinking Questions
\n1. Based on the ratio of cholesterol to HDL, what is the patient\u2019s risk for coronary heart
\ndisease?
\n2. If these blood tests were drawn 1 year ago, what treatment would have been indicated?
\n3. Could surgery have been avoided?<\/p>\n
______________________
\nTo determine the patient’s risk for coronary heart disease based on the ratio of cholesterol to HDL (high-density lipoprotein), we need the values for both cholesterol and HDL. According to the provided information, the patient’s cholesterol level is 502 mg\/dL and HDL level is 29 mg\/dL.
\nTo calculate the ratio, we divide the total cholesterol by the HDL level:
\nCholesterol\/HDL ratio = Total cholesterol (mg\/dL) \/ HDL (mg\/dL)<\/p>\n
In this case, the ratio would be:
\nRatio = 502 mg\/dL \/ 29 mg\/dL = 17.31<\/p>\n
Based on the ratio of 17.31, the patient’s risk for coronary heart disease would be considered high. A higher ratio indicates an increased risk, as it suggests a higher level of LDL (low-density lipoprotein) cholesterol relative to the protective HDL cholesterol.<\/p>\n
If the blood tests were drawn 1 year ago, it is important to consider the specific values of the blood tests at that time. However, based on the information provided in the case study, we can make some general observations.
\nThe patient’s cholesterol level was 502 mg\/dL, which is above the recommended level of less than 200 mg\/dL. Additionally, the LDL level was 189 mg\/dL, exceeding the normal range of 60-180 mg\/dL. These results indicate elevated levels of total cholesterol and LDL cholesterol.<\/p>\n
If these blood test results were drawn 1 year ago, they would suggest the presence of dyslipidemia, particularly type IIa hyperlipidemia, which is characterized by elevated LDL cholesterol levels. The treatment indicated would likely involve lifestyle modifications such as dietary changes, regular exercise, and possibly the use of cholesterol-lowering medications (statins) to manage the dyslipidemia and reduce the risk of coronary heart disease.<\/p>\n
Based on the information provided, surgery was performed to address the patient’s condition, including mitral valve replacement and aortocoronary artery bypass graft. The surgery was indicated due to the presence of coronary artery disease, significant narrowing of the left coronary artery, and mitral regurgitation observed in the diagnostic tests.
\nWithout more information about the severity and extent of the coronary artery disease and mitral regurgitation, it is difficult to determine if surgery could have been avoided. However, considering the patient’s symptoms of angina, poor heart muscle function at the site of ischemia, and the presence of significant narrowing in the left coronary artery, surgical intervention was likely necessary to alleviate the symptoms, improve cardiac function, and reduce the risk of further complications such as myocardial infarction.<\/p>\n","protected":false},"excerpt":{"rendered":"
Pagana: Mosby\u2019s Manual of Diagnostic and Laboratory Tests, 6th Edition Angina Case Studies The patient was a 48-year-old man admitted to the coronary care unit complaining of substernal chest pain. During the 4 months preceding admission, he noted chest pain radiating to his neck and jaw during exercise or emotional upsets. The pain dissipated when […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[563],"tags":[10579,10266,10467,10470,10471,10466,10510,10468,10461,10650,10463,10464,10465,10469,10462,10578],"class_list":["post-122649","post","type-post","status-publish","format-standard","hentry","category-study-bay","tag-buy-essay","tag-cheap-essay-writers","tag-do-my-university-assignment-for-me","tag-essay-pro-dissertation-writers","tag-get-assignments-done","tag-homework-help-services-best-websites","tag-i-need-help-writing-a-page-paper-assignment","tag-i-need-help-writing-my-homework","tag-masters-essays","tag-pagana-mosbys-manual-of-diagnostic-and-laboratory-tests","tag-pay-someone-to-write-a-paper-for-you","tag-phd-essay-writers","tag-research-paper-writing-service-for-any-topic","tag-study-bay-essay","tag-website-that-writes-assignments","tag-write-my-assignment-ireland"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/posts\/122649","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/comments?post=122649"}],"version-history":[{"count":1,"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/posts\/122649\/revisions"}],"predecessor-version":[{"id":122653,"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/posts\/122649\/revisions\/122653"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/media?parent=122649"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/categories?post=122649"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/assessments\/wp-json\/wp\/v2\/tags?post=122649"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}