A forty five year old engineer present to the ER complaining

A forty five year old engineer present to the ER complaining of a severe, intense, precordial, crushing sensation with pain radiating to the left shoulder and down the inside of the left arm, triggered by exercise. The chest discomfort brought on by the exertion is relieved by rest. ER EXAMINATION RESULT ARE THE FOLLOWING NINTY –eight beats/min heart rate, blood pressure of 160/110mmHg , and a respiratory rate of twenty-four breaths/min. EKG is performed and reveals ventricular extrasystole arrhythmia (premature ventricular contraction(PVC) as well as ST segment depression and decreased R-wave height. An exercise tolerance test is performed which demonstrates a downword slopping ST SEGMENT. Coronary angiography shows luminal obstructon greater than 75% (91 percent) in three major coronary vessels, including the left anterior interventricular( descending) coronary artery . the patient is started on nitroglycerin, beta-blocker and calcium channel blockers. Angioplasty is scheduled for the next morning.

5. which set of lab would you order to confirm your diagnosis?

6. what role does tPA( tissue plasminogen activater) play in this case, if any?

Solution

5. which set of lab would you order to confirm your diagnosis?

Answer: Angina lab or angioplasty lab, in which electrocardiogram and chest X-ray is going to be performed to diagnose presence of angina pectoris due to ischameia

6. what role does tPA( tissue plasminogen activater) play in this case, if any?

Answer: TPA is glycoprotein and it is released from the vascular endothelial cells that enable any clot or embolus lysis in the presence of fibrin so that finally forms plasmin. Therefore, that TPA is the measure of angina pectoris and plaque rupture