Medicine Newbie: Cardiogenic shock secondary to anterolateral myocardial infarction

Tuesday, 19 December 2017

Cardiogenic shock secondary to anterolateral myocardial infarction

Topics to search:
Hemodialysis
Anterolateral MI
Cardiogenic shock
ECG
STEMI
Diagnosis
Causes
Emergency Medicine (eMedicine)
ICD-10

I have chosen this topic for this post because it is a real problem and a real cause of death. It happens even with the best care afforded. It happens and it runs in families. There are risk factors. There are clear signs to look out for. It is an end-point of a chronic disease process. It doesn't just appear out of the blue. So how do we go about picking out bits and pieces and learn about this condition?

I will write an abridged scenario. See if you can clearly see how the disease progressed from A to Z. This is a real case scenario that occurred on 16 December 2017.

SCENARIO

A 60-year old Malay diabetic female with healed diabetic foot, cataract and partial sight felt fatigued following dialysis. She was brought to a Government hospital on 12 Dec 2017 at 8 pm, where she was warded on 13 Dec 2017 at 2 am. She was conscious. She was hospitalised for pulmonary emphysema with coughing and hypotension. She was treated and felt better the following day, 14 Dec 2017. However, her BP dropped to critical level and she was rushed to ICU, where BP was stabilised. She was still conscious. It was 15 Dec 2017. Later in ICU, her BP dropped again and she suffered an extensive acute myocardial infarction (massive heart attack) at 10 am. She was rushed to CCU, where she became unconscious. Her condition worsened by 2 pm, and she suffered a cardiogenic shock. She passed away at 3:40 pm on 16 Dec 2017.

Here are some tough questions regarding the passage above.

What is myocardial infarct/infarction (MI)?
Why does MI occur?
What are the causes of MI?
Who are at risk of MI?
What are diabetic complications?
Will all diabetics die from MI?
Will all diabetics suffer from cardiogenic shock?
Can the patient be saved after MI?
Can the patient still be saved after cardiogenic shock?
Why does cardiogenic shock occur secondary to MI?
Are there devices which can be used following MI?
Which type of MI is fatal?
What is STEMI?
Which part on the heart does anterolateral aspect refer to?
What is the cause of anterolateral MI?
Which part of the coronary artery is occluded in anterolateral MI?
Why is ECG essential in Emergency Medicine?
How will ECG indicate anterolateral MI?
What is cardiac aneurysm?
When are visitors allowed to visit the unconscious patient in CCU?
Who is allowed to visit patients in CCU?
Is ICU or CCU a terminal place (for end of life)?
Will every patient admitted to ICU or CCU never survive?
Will surviving family members need counselling? For what & why?
Can food cause diabetes? How & why?
Can food cause heart disease? How & why?
Can food kill?
How much do you think a 5-day hospital stay as in this case would cost in Malaysia today?
How much does dialysis cost today?
How often do diabetics need dialysis?
What are the physiological responses to hemodialysis that may cause intradialytic hypotension (IDH)?
What are the complications following dialysis?
Is dialysis essential?
Are there risks with dialysis?
What are medications for diabetics who need dialysis?
How safe is dialysis today? Can dialysis cause death?
What is the ICD-10 code for the scenario given above?