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Case study: Acute Coronary Syndrome
Thomas is a 60-year-old male with severe shortness of breath, brought in by ambulance to the emergency room. He has a history of childhood rheumatic fever after which he developed rheumatic heart disease. Six years ago, he was diagnosed with Type 2 diabetes mellitus (NIDDM) and commenced on metformin. For many years prior, he has suffered from hypertension and hyperlipidaemia, for which he has been taking aspirin, enalapril and simvastatin. He also had four-vessel coronary artery bypass surgery three years ago after developing exertional angina. Since his surgery, Thomas has had no complaints of chest pain.
Over the past week, however, he has complained of increasing of shortness of breath while walking and has noted swelling in his feet and ankles. He has also been unable to lie flat in bed for the past two nights and has resorted to sleeping on three pillows. Last night he woke at 2.00am short of breath to the point that he had to sit up in his recliner. At about 3.00am he rose to go to the toilet, but by the time he tried to return to the recliner, his shortness of breath had become extreme. Thomas’s wife heard him struggling to breathe and found him leaning against the bedroom doorway, looking ‘blue’. She immediately called an ambulance. On arrival of paramedics he was sitting in his recliner gasping for breath. Paramedics noted he was peripherally cyanosed with a BP of 189/103 mmHg. Chest auscultation revealed widespread crackles bilaterally from base to apices and scattered inspiratory and expiratory wheeze. His initial SpO2 (on room air) was 73% and he was complaining of retrosternal chest pain. After the administration of sublingual glyceryl trinitrate (GTN) and a GTN patch, oral aspirin and intravenous morphine and frusemide, he was commenced on 10 cmH2O CPAP with a FiO2 of 0.4


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  • Uploaded By : Brett
  • Posted on : September 20th, 2019

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