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CCU Case Conference
Chief Complaint ,[object Object]
History of Present Illness ,[object Object],[object Object]
Past Medical History ,[object Object],[object Object],[object Object]
[object Object]
 
South Asians and CV risk
Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Assessment 8.5 8.5 – 10.5 Calcium (mg/dl) 136 70 - 110 Glucose (mg/dl) 1.5 0.6 – 1.5 Creatinine (mg/dl) 20 8 – 25 Urea nitrogen (mg/dl) 22 23.0 – 31.9 Carbon dioxide (mmol/liter) 102 100 – 108 Chloride (mmol/liter) 5.4 3.4 – 4.8 Potassium (mmol/liter) 137 135 – 145 Sodium (mmol/liter) CHEMISTRY ON ADMISSION REFERENCE RANGE TEST
Laboratory Assessment 0 2-8 Bands 1.1 11.3 – 13.3 INR 13.9 22.1 – 35.1 Partial-thromboplastin time (sec) 269 150,000 – 300,000 Platelet Count (per mm 3 ) 11 4 – 11 Monocytes 15 22 – 44 Lymphocytes 74 40 – 70 Neutrophils Differential Count (%) 15.0 4,500 – 11,000 White-cell count (per mm 3 ) 41.3 41.0 – 53.0 Hematocrit (%) 13.9 13.5 – 17.5 Hemoglobin (g/dl) HEMATOLOGY ON ADMISSION REFERENCE RANGE TEST
Laboratory Assessment ,[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
 
 
 
Hospital Course ,[object Object],[object Object]
Hospital Course ,[object Object],[object Object]
Hospital Course ,[object Object]
 
 
 
 
 
 
Hospital Course ,[object Object]
 
 
Post – operative course ,[object Object],[object Object]
Post – operative course ,[object Object]
Ventricular Septal Rupture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1  Birnbaum, NEJM 2002 2  Crenshaw, Circulation 2000
The Evolution of an MI 7 - 10 d 3 - 4 d 30 m - 4 h 10 - 14 d 2 -8 wk Dense collagenous scar  >2 mo  Increased collagen deposition, with decreased cellularity  2–8 wk  Well-established granulation tissue with new blood vessels and collagen deposition  10–14 days  Well-developed phagocytosis of dead cells; early formation of fibrovascular granulation tissue at margins  7–10 days  Beginning disintegration of dead myofibers, with dying neutrophils; early phagocytosis of dead cells by macrophages at infarct border  3–7 days  Coagulation necrosis, with loss of nuclei and striations; brisk interstitial infiltrate of neutrophils  1 to 3 days Ongoing coagulation necrosis; myocyte hypereosinophilia; marginal contraction band necrosis; early neutrophilic infiltrate  12 to 24 hrs Early coagulation necrosis; edema; hemorrhage  4 to 12 hrs Variable waviness of fibers at border  30 min to 4 hrs Relaxation of myofibrils; glycogen loss; mitochondrial swelling  0 to 30 min Morphological Changes Time
[object Object],[object Object],[object Object]

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vsr

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  • 9. Laboratory Assessment 8.5 8.5 – 10.5 Calcium (mg/dl) 136 70 - 110 Glucose (mg/dl) 1.5 0.6 – 1.5 Creatinine (mg/dl) 20 8 – 25 Urea nitrogen (mg/dl) 22 23.0 – 31.9 Carbon dioxide (mmol/liter) 102 100 – 108 Chloride (mmol/liter) 5.4 3.4 – 4.8 Potassium (mmol/liter) 137 135 – 145 Sodium (mmol/liter) CHEMISTRY ON ADMISSION REFERENCE RANGE TEST
  • 10. Laboratory Assessment 0 2-8 Bands 1.1 11.3 – 13.3 INR 13.9 22.1 – 35.1 Partial-thromboplastin time (sec) 269 150,000 – 300,000 Platelet Count (per mm 3 ) 11 4 – 11 Monocytes 15 22 – 44 Lymphocytes 74 40 – 70 Neutrophils Differential Count (%) 15.0 4,500 – 11,000 White-cell count (per mm 3 ) 41.3 41.0 – 53.0 Hematocrit (%) 13.9 13.5 – 17.5 Hemoglobin (g/dl) HEMATOLOGY ON ADMISSION REFERENCE RANGE TEST
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  • 35. The Evolution of an MI 7 - 10 d 3 - 4 d 30 m - 4 h 10 - 14 d 2 -8 wk Dense collagenous scar >2 mo Increased collagen deposition, with decreased cellularity 2–8 wk Well-established granulation tissue with new blood vessels and collagen deposition 10–14 days Well-developed phagocytosis of dead cells; early formation of fibrovascular granulation tissue at margins 7–10 days Beginning disintegration of dead myofibers, with dying neutrophils; early phagocytosis of dead cells by macrophages at infarct border 3–7 days Coagulation necrosis, with loss of nuclei and striations; brisk interstitial infiltrate of neutrophils 1 to 3 days Ongoing coagulation necrosis; myocyte hypereosinophilia; marginal contraction band necrosis; early neutrophilic infiltrate 12 to 24 hrs Early coagulation necrosis; edema; hemorrhage 4 to 12 hrs Variable waviness of fibers at border 30 min to 4 hrs Relaxation of myofibrils; glycogen loss; mitochondrial swelling 0 to 30 min Morphological Changes Time
  • 36.

Notas do Editor

  1. 4 main risk factors associated w/ increased risk is smoking, high Apo protein, history of hypertension, and diabetes. In this study they also found that the rates of fruit and vegetable consumption were quite lower