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Case Studies
Quiz of the month – June 2022
Take our patient case study quiz specially curated for you by our Faculty Member, Prof. Chern-En Chiang.
Case Study: A 67-year-old male comes to the ER with the complaint of excruciating anterior chest pain for 1-hour. The parameters measured in the ER are as follows:
Vital parameters
Blood pressure: 146/78 mm Hg
Heart rate: 92/min
Respiratory rate: 16/min
ECG shows ST elevation over V1-V3, suggesting acute anterior MI, and pathological Q waves over leads II, III and aVF. Toponin I was 15.40 ng/mL. Urgent coronary angiograph shows total occlusion over LAD-M, patent left main, patent left circumflex, and 80% stenosis over RCA-M. Left ventriculogram showing moderate hypokinesis over anterior septal area and mild hypokinesis over inferior wall with an EF of 44%. Primary PCI with 2 DES over LAD-M and RCA-M was performed uneventfully.
Past history
Inferior myocardial infarction 4 years with medical treatment
HT for more than 10 years with regular treatment
Type 2 diabetes for 8 years
Denied smoking
Obesity with a BMI of 30.5
Lab data
Na 134 meq/L, K 4.2 meq/L
Cr 1.05 mg/dL, eGFR 73 mL/min (CKD-EPI),
UACR 350 mg/g
ALT 32 mg/dL
HbA1c 8.3%
LDL-C 98 mg/dL, HDL-C 28 mg/dL, triglyceride 259 mg/dL
Toponin I 15.40 ng/mL, hs-CRP 18.2 mg/dL
Lp(a) 83 mg/dL [upper limit of normal Lp(a) = 30 mg/dL]
Medication history
before admissionAmlodipine 5 mg OD, valsartan 160 mg OD, bisoprolol 5 mg OD
Metformin 850 mg BD
Aspirin 81 mg OD
Atorvastatin 20 mg OD
Investigation
Acute MI after successful PCI, and this is a second MI (previous inferior MI)
Post-MI LV dysfunction (LVEF of 44%)
Uncontrolled diabetes (HbA1c 8.3%)
Suboptimal control of lipid levels (LDL-C 98 mg/dL)
A very high level of Lp(a) (83 mg/dL)