Case outline

Mr Ahmad is a 60-year-old man who has experienced an episode of crushing central chest pain
while climbing the stair case. His wife taken him to the Accident and Emergency Department.
On admission, Ahmad is sweaty, clammy, nauseated and short of breath. He is complaining of
chest pain radiating to his left arm. This is Ahmad’s first admission to hospital and no any past
medical history. The patient was a smoker for the past 4 years and used to smoke 3–4 cigarettes per
day, and takes alcohol at weekends only. During admission, he looks anxious and is concerned
about his family. Family history mother died due to heart attack 10 years ago. Ahmad was taken
to red zone and you assign to take care of him in emergency unit

Vital sign in red zone as below:

 Respiratory rate: 20 breaths per minute

 Oxygen saturations: 96%
 Blood pressure: 150/95 mmHg
 Pulse: 100 beats per minute
 Temperature: 37ºC.

On admission to hospital, an electrocardiograph (ECG) has been undertaken. Peter has

been diagnosed with an anterior ST segment elevation myocardial infarction (anterior

STEMI). Blood samples have also been drawn for urea and electrolytes (U&E), full

blood picture (FBP) and highly sensitive troponin T.

1. Discuss Peter’s immediate problems and explain these using your knowledge of pathophysiology
base on the current literature
2. Differentiate between STEMI and NSTEMI in relation to clinical and diagnosis
presentation
3. Outline the nursing care that Ahmad should receive in relation to the problems
Identified base on the current literature
 A 12-lead ECG be recorded as a matter of urgency during the initial assessment

4. Discuss the ECG that has been recorded with current reference to the diagnosis.
5. Which coronary artery is most likely responsible for this patient’s and give your
justification
6. Discuss the reason for a high-sensitivity troponin T

The cardiologist has decided to take Ahmad to the cardiac catheterization laboratory

(cath lab) to undergo a percutaneous coronary intervention (PCI) as opposed to giving

him thrombolytic therapy. The cardiologist wants Ahmad to have clopidogrel 600 mg and

aspirin 300 mg prior to transfer to the catheterization laboratory.

7. Briefly discuss the benefit of PCI in comparison to thrombolytic therapy.

8. Discuss care of patient post PCI with current reference
9. Discuss the modes of action of clopidogrel and aspirin and their use prior to PCI.