Question

S.H. is a 25-year-old man who comes to the emergency department with chest pain radiating to the arm, behind sternum.

Subjective Data

• Character. Substernal chest pain, pressure, heaviness, or discomfort. Other sensations include a squeezing, aching, burning, choking, strangling, or cramping pain.
• Severity. Pain score of 10
• Location. Behind middle or upper third of sternum radiating to the arm.

Objective Data

• Physical Examination
• Blood pressure 189/92, pulse 120, temperature 97.7° F, respirations 22
• Labs

Discussion Questions

1.What is CHF? How is it different from MI?

2.Based on the assessment, what do you think S.H. has and why?

3.What other diagnostic tests may be ordered for S.H.?

4.What labs and what findings will it show if SH has CHF?

Answer 1

1. CHF. Is a congestive heart failure, in which the heart loose the capacity to pumb blood as well as it should. If it doesn't get enough medical attention ,it will end up with a heart failure.

MI or myocardial infarction is the blockage of the blood flow to the heart muscle. When a blood clot blocks the blood flow to the heart ,the heart tissue looses oxygen and dies. It will end up with a heart attack.

CHF shows the inability of heart to pumb enough blood. But in case of MI heart attack will occure due to necrosis or or tissue death of the heart muscles due to occlusion or narrowing of arteries.

2.We can conform that SH has myocardial infarction .because he has chest pain which is radiating to his arm and behind the sternum. ( that is one of the main sign of the patient who has with MI)  

Also he has blood pressure of 189/ 92.and plse rate of 120. In MI the patient will show high blood pressure and high heart rate. (hypertension and tachycardia)   But in case of CHF the heart will loose the ability to pump the blood faster .so the patient must have lower blood pressure and low heart rate. (hypotension and bradycardia)

From this itself we can conclude that SH has MI.

3.SH should under go the investigations such as

# chest xray. ( which allows the doctor to see the size of the heart)  

# ECG or electocardiogram

# Echo cardiogram ( the sound waves obtains the Images of a moving heart. Also we can analyze the heart chambers and valves. Also it helps to identity the area of heart has been damaged.)

# Angiography ( in this a dye is injected through the vein to the heart. It helps to make the arteries visible on the x ray .easily we can find the narrowing and occlusion of the arteries.

# Cardiac CT and MRI scan ( this will also helps to get the images of the heart.)  

# Troponin I ( this also a recommended test for MI.it will helps to identity the fall of concentration)  

4.Laboratory tests that may be ordered include: B-type natriuretic peptide (BNP) or N-terminal pro-BNP—measure the concentration of a hormone produced by the left ventricle .