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After completing this case study, the reader should be able to:
Determine the goals of pharmacotherapy for patients with ST-segment elevation myocardial infarction (STEMI).
Discuss interventional strategies for patients with STEMI, and understand the pharmacotherapeutic agents used with interventions.
Design an optimal therapeutic plan for the management of STEMI, and describe how the selected drug therapy achieves the therapeutic goals.
Identify appropriate parameters to assess the recommended drug therapy for both efficacy and adverse effects.
Provide appropriate education to a patient who has suffered STEMI.
“This is the worst pain I have ever felt in my life.”
Gary Roberts is a 68-year-old man admitted to the ED complaining of chest pressure/pain lasting 20–30 minutes occurring at rest. He describes the pain as substernal, crushing, and pressure-like that radiates to his jaw and is accompanied by nausea and diaphoresis. The pain first started approximately 6 hours ago after he ate breakfast and was unrelieved by antacids or SL NTG × 3. He also states that he has been experiencing intermittent chest pain over the past 3–4 weeks with minimal exertion.
CAD with PCI with a drug-eluting stent (DES) 3 years ago
Father died from heart failure at age 75 and mother is alive at age 88 with HTN and type 2 DM.
(+) Tobacco × 20 years but quit when he received his DES 3 years ago; drinks beer usually on weekends; denies illicit drug use
Metoprolol tartrate 25 mg PO BID
Atorvastatin 40 mg PO QHS
Positive for some baseline CP on exertion for the past 3–4 weeks, now with CP at rest
WDWN man, A&O × 3, still with ongoing chest pain, somewhat anxious
BP 145/92, P 89, RR 18, T 37.1°C; Wt 95 kg, Ht 5′10″
PERRLA, EOMI, fundi benign; TMs intact
No bruits; mild JVD; no thyromegaly
Few dependent inspiratory ...