session 2: Mrs. Newman's indigestion

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session 2: Mrs. Newman's indigestion by Mind Map: session 2: Mrs. Newman's indigestion

1. Step 6

1.1. Review session 1

1.1.1. Summary of step 5

1.2. Report new knowledge

1.2.1. Anatomy the heart in the inferior medial mediastnum, the apex (left ventricle) the base (right ventricle) the chambers bones ribs clavicle sternum lungs thoracic trunk blood vessels coronary arteries muscles pectoralis major and mino serratus anterior intercostal muscles neck innervation

1.2.2. Pathphysiology theories of pain radiation

1.2.3. Patholog angina heart attack (MI) 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 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 no serguries, no checks, no diabetes, no hyper tension, smokers, no alcohol,

3.1.3. Drug history / allergy no allergies, no medications. just the antacid

3.1.4. Family history a brother died unknown cause in his 40s

3.1.5. Social / occupational history smokers 25, regular food mostly rise and meat, a lot of coffee, financial problems

3.1.6. Physical examination under weight is 55 kg, slim skinny, pale 90 regular HR respiratory 20 130/80 Bp pain score about 3

3.1.7. tests results tropnin is 0.3 mg/l then 0.8 mg/l ECG shows ST elevated cheratine/kinase Mb is not available LDL is 5.9. normal 2- 3.4 mmol/L angiography shows stenosis in the left descending artery