Sunday, August 3, 2008

Case 9

A 58 years old woman with history of hypertension, and coronary artery disease, presented to the emergency room with severe retrosternal pain, and dyspnea.

She is on Metoprolol, aspirin and Enalapril as an outpatient.

On physical examination, she is afebrile, blood pressure 142/84, pulse rate 92 /min, and respiratory rate 18/min. Cardiovascular exam reveals normal first and second heart sounds, no extra heart sounds, with no murmurs, the lungs are clear, and the peripheral pulses are equal and palpable, the rest of the physical examination is normal.ECG shows ST-segment elevation in leads II, III, and aVF. The intern on call recognized the ECG findings and called for stat cardiology consult, and activated the cardiac cath lab. Patient undergoes angioplasty with placement of bare metal stent.

Next morning patient had no complications, and asked the medical team to go home.


1-Which coronary artery is occluded in this case?

2-In addition to her outpatient medications, which medication/medications would you add and for how long?

5 comments:

ramashesai said...

1) Right coronary artery
2) Plavix for 3 months.

Ranjitha said...

RCA
Will add clopidogrel, statin

idiotbox said...

RCA Territory involved.
Add Zocor indefinitely and plavix at least for a month to 3 months.

prabodh said...

1.) RCA/LEFT CX
2.)ASA 325 mg + clopidrogel 75 mg for atleast one month followed by ASA 81 mg indefinitely and clopidrogel 75 mg ideally upto 12 months.

prabodh said...

1.) RCA/LEFT CX
2.)ASA 325 mg + clopidrogel 75 mg for atleast one month followed by ASA 81 mg indefinitely and clopidrogel 75 mg ideally upto 12 months.