Case Study ? Thorax;Presentation/History;A 52-year-old insurance adjuster is brought to the hospital in an ambulance. His wife, who accompanied him, stated that during dinner he started to complain of excruciating chest pain in the region of the sternum. These symptoms were accompanied by nausea, vomiting, and severe shortness of breath. She also pointed out that for several years the patient had been suffering from chest pain that radiated into the left arm, particularly after physical effort or emotional upsets.;Examination;On admission the patient appears in shock. His skin is ashen gray with some cyanosis (bluish tinge), and is cold and clammy. His blood pressure is low, his pulse is quite weak, and his pulse rate is 110 per minute. His respirations are noisy and gasping. On auscultation of the lungs, abnormal breaths sounds are heard. His heart sounds are feebly and arrhythmic. In spite of oxygen application, intravenous injection of circulatory stimulants, electric defibrillation and terminal cardiac massage, the patient expires within two hours of admission. At autopsy there is found marked narrowing of both coronary arteries and many of their branches, due to atherosclerosis of the vessel wall. There is an old occlusion in the first portion of the right coronary artery and a fresh intimal hemorrhage in the anterior interventricular branch near its origin from the left coronary artery. This, in combination with a fresh blood clot, has completely occluded the anterior interventricular branch.;?;Discussion Thread;Questions;Ischemic heart disease, i.e., heart disease caused by insufficient blood supply to the heart muscle, is one of the most frequent conditions encountered in patients past 40 years of age. It is the leading cause of death in the United States. It is the function of the coronary arteries to carry blood to the myocardium and thus maintain its nutrition. When the lumen of the coronary artery becomes narrowed or obliterated due to atherosclerosis of the intima, the portion of the myocardium supplied by the affected artery suffers from lack of oxygen (hypoxia) and becomes damaged. This myocardial hypoxia may result in rapid death, as happened in our patient. It is generally due to ventricular fibrillation. The latter condition is a cardiac arrhythmia leading to completely disorganized ventricular excitation and ineffective contraction resulting in circulatory failure and, frequently, death. The decisive factor in the life of individuals with coronary artherosclerosis is the state of the coronary circulation. Identify the arterial supply to the heart and give the origin of these arteries. The right and left coronary arteries are middle-sized muscular arteries that arise from the right and left aortic sinuses of the first part of the aorta just distal to the semilunar valves. The main arteries run in the epicardial fat of the atrioventricular and interventricular grooves and are partly concealed by fact and in some locations also by thin layers of ventricular myocardium, so that dissection becomes necessary for their demonstration.;To what extent does the statement that the right coronary artery supplies the right heart, and the left coronary artery the left heart, require qualification?;What is an end-artery and do coronary arteries qualify as such?
Paper#18129 | Written in 18-Jul-2015Price : $32