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Cardiovascular system

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. 5206535
. 5406797

History
A 65-year-old man presented to the emergency room with a

recent (6-hour) history of severe chest pain radiating to his left


arm. He was suspected to have had a "heart attack." Coronary
angiography revealed a complete occlusion of the left anterior
descending branch about 2 cm from its origin. He was given a
therapeutic dose of recombinant human tissue plasminogen
activator (t-PA). This treatment restored coronary artery blood
flow, and his chest pain improved. Simultaneously, he was
started on one tablet of aspirin per day.
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Seven days later, he noted swelling of both legs

and feet and was found to have pitting edema of


the legs; his liver was somewhat enlarged; and his
neck veins (jugular) appeared full. He was given
diuretics and salt-restricted diet.
A few days later, he developed dypsnea,
orthopnea, cough with pink frothy sputum. He
became very breathless and died suddenly.
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Section I

severe chest pain radiating to his left


arm.
complete occlusion of the left anterior
descending branch
tissue plasminogen activator (t-PA).
one tablet of aspirin

Section II

swelling of both legs and feet


liver was somewhat enlarged
neck veins (jugular) appeared full
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Blood supply of the heart

Coronary angiography

LCA

LAD

Normal Left anterior coronary artery

LAD
Blockage
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Cardiac enzyme investigation


Time Course for Serum marker
in acute MI

Cardiac enzyme can help you to prove


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ECG

He was given a therapeutic dose of


recombinant human tissue plasminogen
activator (t-PA). This treatment restored
coronary artery blood flow, and his chest
pain improved. Simultaneously, he was
started on one tablet of aspirin per day.

Plasminogen

Tissue
plasminogen
activator (tPA)

Plasmin

Fibrin

Fibrin Degradation
Products

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Aspirin
Arachidonic acid

Cyclooxygenase1
Prostaglandin G2
Thromboxane
synthase

Thromboxane A2

decreased platelet
activation and
aggregation
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Medical use

Pulmonary embolism

Myocardial infarction

Stroke

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He was given diuretics and saltrestricted diet.

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Diuretics

Loop diuretics are diuretics that act at the


ascending loop of Henle in the kidney

Furosemide

The progression of heart failure

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Question

At the time of admission, What is the


histopathologic finding in this patient?

Fibrosis and collagen deposition


B. Plasma cells and caseous necrosis
C. Abundant neutrophils and monocytes
D. Monocyte infiltration and
neovascularization
E. Coagulation necrosis with few
A.

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SEQUENCES OF PATHOLOGIC CHANGES

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At the time of admission, What is the


histopathologic finding in this patient?

Fibrosis and collagen deposition


B. Plasma cells and caseous necrosis
C. Abundant neutrophils and monocytes
D. Monocyte infiltration and
neovascularization
E. Coagulation necrosis with few
A.

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He was given diuretics and saltrestricted diet.

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Diuretics

Loop diuretics

Furosemide

Which of the following mechanisms


is the most likely inhibition of
aspirin ?

A. ADP pathway
B. cAMP activation
C. Plasmin metabolism
D. Thromboxane A2 synthesis
E. glycoprotein IIb/IIIa receptor

Which of the following mechanisms


is the most likely inhibition of
aspirin ?
A. ADP pathway
B. cAMP activation
C. Plasmin metabolism
D. Thromboxane A2 synthesis
E. glycoprotein Iib/IIIa receptor

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