Cardiovascular Pathology - Case 5 - Part 4
   

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He was started on Aldactone and furosemide for his severely depressed ejection fraction, and was anticoagulated for a possible mural thrombus in the face of apical akinesis. The balloon pump was removed after stabilization.

He was transferred to the Cardiology Floor on day 7 and did quite well. He was ambulating in the hallways with minimal difficulty and was discharged on day 12.

The patient was home for one day and returned to the hospital with epigastric discomfort, increasing nausea, cold sweats, chills and difficulty sleeping. The next day his abdominal pain increased and a CT scan of the abdomen was performed. Shortly thereafter the patient became hypotensive with pressures in the 70's and he went into a pulseless electrical activity arrest. Despite ACLS protocol with maximum epinephrine, atropine and fluids he could not be resuscitated.

Date Troponin I Ref Interval
6-22-03 3.2 ng/ml 0.0 - 0.4
6-23-03 2.7 ng/ml 0.0 - 0.4
6-24-03 2.2 ng/ml 0.0 - 0.4

 

EKG from 6-22-03 on admission
EKG from 6-24-03 prior to death
CT scan of the abdomen with views of the lower chest

1. The Admission H&P of 6-22-03 reveals the concern for epigastric pain. What could be causing this?

2. What does the Troponin tell you?

3. Review the EKG from this admission, are there any changes?

4. Review the CT scan performed on 6-23-03, what do you see?

5. What could be the cause of death?