1. Step 6
1.1. Review session 1
1.1.1. Summary of step 5
1.2. Report new knowledge
1.2.1. Anatomy
1.2.1.1. the heart
1.2.1.1.1. in the inferior medial mediastnum, the apex (left ventricle) the base (right ventricle) the chambers
1.2.1.2. bones
1.2.1.2.1. ribs
1.2.1.2.2. clavicle
1.2.1.2.3. sternum
1.2.1.3. lungs
1.2.1.4. thoracic trunk
1.2.1.5. blood vessels
1.2.1.5.1. coronary arteries
1.2.1.6. muscles
1.2.1.6.1. pectoralis major and mino
1.2.1.6.2. serratus anterior
1.2.1.6.3. intercostal muscles
1.2.1.7. neck innervation
1.2.2. Pathphysiology
1.2.2.1. theories of pain radiation
1.2.3. Patholog
1.2.3.1. angina
1.2.3.2. heart attack (MI)
1.2.3.3. aortic dissection
2. Step 8
2.1. Diagnostic decision
2.1.1. MI
2.2. Mechanism
2.2.1. high LDL level causing plaque formation in the coronary artery which lead to hypoxia in the myocardial muscles and coagulative necrosis .
2.3. Presentation
2.3.1. chest discomfort and radiated pain in the jaw and neck, sweating and shortness of breath, looks pale.
2.4. Supporting data
2.4.1. elevation of the ST segment
2.4.2. high troponin 0.3 - 0.8
2.4.3. angigrophy shows stenosis in the left descending artery
2.4.4. smoker
2.4.5. high LDL level 5.9 mmol/L
2.4.6. stress
2.4.7. family history of sudden death
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complain
3.1.1.1. discomfort, heaviness, sweaty, on snd off fot long time but this time it didn't go away, no shortness of breath, increase with activity, goes with rest.
3.1.2. Previous medical / surgical history
3.1.2.1. no serguries, no checks, no diabetes, no hyper tension, smokers, no alcohol,
3.1.3. Drug history / allergy
3.1.3.1. no allergies, no medications. just the antacid
3.1.4. Family history
3.1.4.1. a brother died unknown cause in his 40s
3.1.5. Social / occupational history
3.1.5.1. smokers 25, regular food mostly rise and meat, a lot of coffee, financial problems
3.1.6. Physical examination
3.1.6.1. under weight is 55 kg, slim skinny, pale
3.1.6.2. 90 regular HR
3.1.6.3. respiratory 20
3.1.6.4. 130/80 Bp
3.1.6.5. pain score about 3
3.1.7. tests results
3.1.7.1. tropnin is 0.3 mg/l then 0.8 mg/l
3.1.7.2. ECG shows ST elevated
3.1.7.3. cheratine/kinase Mb is not available
3.1.7.4. LDL is 5.9. normal 2- 3.4 mmol/L
3.1.7.5. angiography shows stenosis in the left descending artery