ST elevation myocardial infarction presenting as indigestion and jaw pain

¶ … Patient Overview -- Mr. C. is a 52-year-old business executive with indigestion that an entire roll of TUMS did not help. Initially he blamed this on his lunchtime pizza, but his staff convinced him to go to the ER where he presented epigastric pain. An EKG was done indicating ST segment elevation. Additionally, the pain remained unrelieved after three sublingual nitroglycerine tablets. Three doses of morphine sulfate given intravenously relieved the pain enough for a transfer to the cardiac unit. Mr. C's skin is clammy and cool; he has inspiratory crackles, temp of 98.6, 120 pulse, and respiration 24, BP 90/62. The Cardiac monitor showed sinus rhythm with occasional premature ventricular contractions (PVCS). Labs showed elevated isoenzymes, topponis, creatin kinase myocardial bound, and lactic acid dehydrogenase. We find out also that Mr. C has been having dental pain for the past 48 hours.

Part 1 -- The ST segment is the period from the end of ventricular depolarization to the beginning of ventricular repolarization. It is normally isoelectric and lies between the end of the QRS complex and the initial T-wave. ST elevation may be caused by myocardial ischemia or injury or non-ischemic ST segment elevation. It is the vertical distance between the ECG trace and the isoelectric line that indicates the severity of the ST elevation. It is important because of the patient's age and risk factors for cardiac incidence (ST Elevation, 2012).

Part 2 -- For some reason, the patient is experiencing decreased cardiac output, which causes cool clammy skin, shortness of breath, and inspiratory crackles. Based on other factors (labs, etc.) it appears that Mr. C. is experiencing some degree of congestive heart failure (Daines, 2012, p. 89; Hudson, 2012).