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# Case presentation Jane remembers feeling very hot, stressed and confined in her car on the expressway...

###### Question:

Case presentation

Jane remembers feeling very hot, stressed and confined in her car on the expressway as she was on her way down to an important meeting. “I was getting very agitated because the traffic was at a standstill and I only had just over an hour to get there. I knew I wasn’t going to make it,” she remembers.

As she sat in the traffic jam, she began to feel unwell and experienced an aching pain in her chest, which went out through her shoulder and all the way down her arm. “I thought I had cramp but then I was having real difficulty getting my breath and I felt hot and really sick,” she says.

Jane does not recall anything after that but, fortunately, the traffic was at a complete standstill because of an accident up ahead and when she opened the car door and collapsed in the road, the motorists waiting in the queue behind her rushed to Jane’s aid. Jane was transported to a local emergency room for treatment and follow up care.

Jane is 56 years old,is mostly sendentary (< 30 minutes exercise/day), smokes occasionally (< 1 pack/week) and consumes < 7 alcoholic drinks/week.

1. Using the data below, and the case presentation, identify risk factors in this case. (5)

 Test Result Normal Range BMI (weight: 210 lbs Height: 5’8”) 31.9 18.5–24.9 Triglycerides (mg/dl) 225 < 150 High-density Lipoprotein (mg/dl) 42 ≥ 40 Low-density Lipoprotein (mg/dl) 95 < 100 Blood Pressure (mm Hg) 155/95 90–120/60–80 Pulse 90 60–100 Hematocrit (%) 40 36–50 Hemoglobin (g/100 ml blood) 12.4 11–14 Glucose (mg/dl) 140 75–105 Sodium (mmol/L) 140 135–145 Potassium (mmol/L) 4.5 3.5–5.0

2. Which additional blood tests are commonly used to diagnose cardiace muscle damage?

Identify the test, and the purpose of the test in test validity terms (sensitive, specific, predictive value)

3. Identify three additional non-lab procedures used in the diagnosis of damage to cardiac muscle and explain how these are used (5)

Example:

EKG: measures electrical conduction and rhythm. Changes in the EKG along with blood tests can indicate cardiac muscle damage.

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