A male patient of 64 was admitted to the hospital
because of sudden onset severe substernal chest
pain with short breath and palpitation induced
by exertion.
The patient has a history of coronary heart disease
and used to stay in the hospital for a period
time. Two months ago, he had a pain at the costovertebral
angle. Urinalysis showed many RBC. The patient
felt the pain releases after two weeks treatment
with antibiotics.
Physicalexamination:Temp.36.7℃,Pulse78/min, Resp.30/min,
Bp.140/90mmHg, consciousness, moderate nourished,
deep and labored respiration. No any superficial
lymph nodes touched, and no jaundice in appearance.
Coarse moist rales in both lungs, weak and irregular
heart beating. St segment abnormalities were found
on ECG(electrocardiogram) and indicated heart
disease.
Diagnosis: acute myocardial infarction.
Treatment: intravenous infusion and oxygen inhalation
to correct arrhythmia and heart failure. But after
20 hours hospitalization, the patient sudden felt
a severe chest distress and palpitation, failure
of rescue and died at last.
Autopsy finding: ⑴Many atheromatous plaques were
found in the coronary artery and aorta, and there
was a thromboid solid in the left anterior descending
coronary artery.⑵A pale zone was found in the
posterior wall of the left ventricle, and the
anterior wall of the left ventricle and apex were
dark-red in color and very soft in touch.⑶Mural
thrombus was found on the endocardial surface
of the left ventricle.⑷Lungs showed congested(dark
red)and soft, and much pink foamy liquid came
out from the cutting surface.⑸A pale triangle
area was found in the kidney.
For you:
1. Please write down the diagnosis for each
slide.
2. Please describe the development of the coronary
heart disease and the relationship between those
changes in heart, lung and kidney.
3. What’s the main cause of the death.
|
