Cardiology Case Study: Chest Pain and Troponin Levels

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Questions and Answers

What is the primary purpose of Troponin in relation to cardiac health?

It is a marker for pulmonary diseases.

It is a protein involved in blood clotting.

It indicates muscle injury when released into the bloodstream. (correct)

It helps in energy metabolism of heart cells.

Which condition is NOT part of the differential diagnosis for the patient's chest pain?

Aortic Dissection

Acute Coronary Syndrome (ACS)

Pulmonary Embolism (PE)

Acute Rheumatic Fever (correct)

What condition could cause the patient's inability to lie flat?

Coronary Artery Disease

Pulmonary Oedema (correct)

Cardiac Tamponade

Aortic Stenosis

What should be prioritized in management if the patient experiences haematemesis?

Stop the bleeding. Signup and view all the answers

Which medication would generally be avoided in a bradycardic patient?

Beta-blockers Signup and view all the answers

Which factor is NOT associated with reversible airway narrowing?

Airway fibrosis Signup and view all the answers

Which of these conditions is characterized by reversible airway obstruction?

Asthma Signup and view all the answers

What personal history is most likely to increase the probability of asthma?

Family history of asthma Signup and view all the answers

Which symptom combination would most likely indicate increased probability of asthma?

Chest tightness and wheeze Signup and view all the answers

What is a common treatment for a cardiac event indicating ACS?

Dual Antiplatelet Therapy (DAPT) Signup and view all the answers

Which finding on physical examination could indicate fluid overload?

Swollen legs Signup and view all the answers

What indicates a high probability of asthma if symptoms improve with treatment?

Response to adequate therapy Signup and view all the answers

Which imaging technique is commonly used to assess the heart structure and function?

Echocardiogram Signup and view all the answers

Which of the following would decrease the probability of asthma?

Normal PEFR when symptomatic Signup and view all the answers

Which factor could trigger bronchial smooth muscle contraction?

Emotions such as laughter Signup and view all the answers

Which condition is characterized by airway hyper-responsiveness in addition to inflammation?

Asthma Signup and view all the answers

Which clinical feature is suggestive of an alternative diagnosis rather than asthma?

Peripheral tingling without respiratory symptoms Signup and view all the answers

What finding would strengthen the probability of asthma during physical examination?

Presence of symptoms exacerbated by pets Signup and view all the answers

What is an appropriate next step if a trial of asthma treatment yields no response?

Assess inhaler technique and compliance Signup and view all the answers

In children, which symptom alone is NOT commonly associated with asthma?

Occasional headaches Signup and view all the answers

Study Notes

Patient Presentation

Patient: Barry, a 55-year-old male plumber, former semi-professional footballer for Blackburn Rovers.
Smoker (pipe).
Drinks socially.
Presenting complaint: chest pain.

Examination Findings

Chest clear to palpation.
Heart sounds (HS) normal.
Abdomen soft, non-tender (SNT).
No pedal edema.
Right leg more swollen than left, attributed to a football accident 30 years prior, with a metal plate present

Investigations

ECG: sinus rhythm, T-wave inversion.
Chest X-ray: normal.
Bloods (6 hours): Troponin I elevated at 2049 ng/L (normal range 0-58 ng/L).
Bloods (6 hours later): Troponin I significantly elevated at 2846 ng/L.

Troponin Information

Protein in cardiac and skeletal muscle.
Involved in muscle contraction, responsive to calcium.
Released after cardiac injury.
Elevated Troponin levels indicate potential myocardial damage.

Echocardiogram Findings

Mild to moderate aortic stenosis with mild regurgitation.
Normal right ventricular (RV) size and function.
Normal left ventricle structure, impaired function (global hypokinesia, estimated ejection fraction (EF) 25%).
Dilated bi-atrial size and function.
Mild to moderate mitral regurgitation.

Differential Diagnosis

Acute coronary syndrome (ACS).
Aortic dissection.
Myocarditis.

ACS Treatment

Antiplatelet therapy (DAPT, Fondaparinux)
ACE inhibitor
Beta-blocker
Statin

Possible Management

Furosemide (diuretic) acutely.
Uptitrating beta-blocker dose (possibly digoxin).
ACE inhibitor.
Potassium-sparing diuretic.
Coronary revascularization therapy (CRT).

Further Presentation (2 days later)

Shortness of breath (SOB).
Difficulty lying flat.
Leg swelling.

Further Investigations and Results (2 days later)

ECG: ST depression.
Chest X-ray: Signs of congestion and pulmonary edema.
Further Blood test: Further high troponin (1633 ng/L)

Diagnosis

Possible new Myocardial Infarction (MI)
Hospital-acquired pneumonia (HAP).
Aspiration pneumonia.
COVID.
Pulmonary edema, secondary to fast Atrial Fibrillation (AF).

Management (2 days later)

Further investigation and treatment as required, based upon the elevated results of investigations and symptoms.

Discharged

Follow up with cardiology.
Community heart failure team.
Fluid restriction.
Cardiac rehabilitation.

Further Presentation (6 months later)

Sudden onset shortness of breath (SOB).
Chest X-ray: signs of a pneumothorax.

Investigations (6 months later)

High Troponin level, (4729 ng/L).
Likely a pulmonary condition, such as a bullae or pneumothorax.

Type of MI

The presentation suggests an earlier MI or ongoing MI.

Conclusion

Patient with multiple and evolving conditions.
Requires prompt and comprehensive management and a multidisciplinary approach.
Needs to be closely monitored and managed in light of a potential bullae or pneumothorax.
Patient needs a review to understand the potential issues.

Respiratory Diagnoses

Asthma
COPD
Pulmonary embolism
Lung cancer (less likely).
Pneumothorax
Pneumonia

Spirometric Findings

FEV1/FVC ratio less than 0.7, indicates possible obstructive diseases.
Various stages of Spirometry to show moderate to severe obstructive.

Respiratory Anatomy

Includes information about the lungs (lobes, fissures, etc.), bronchial tree, and alveoli.

Respiratory Pathophysiology

Detailed information on Emphysema, including descriptions regarding bullae development.

Treatment Considerations

Antibiotics (abx).
Steroids.
Nebulisers.
Specimen analysis (sputum sample, urinary antigens).
Specialist nurse input.
Aminophylline, NIV.
Spirometry.

Reasons for Leg Swelling

Possible pressure from the lungs (pulmonary conditions).

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Description

This quiz explores a clinical case involving a 55-year-old male presenting with chest pain and elevated troponin levels. It delves into examination findings, ECG results, and cardiac structure abnormalities such as aortic stenosis. Participants will enhance their understanding of cardiovascular assessment and cases related to myocardial injury.