please help answering some CHD cases!

[kapil]

1. A 52 –year-old woman presented with exercise-induced chest pain.Examination was normal except for mild epigastric tenderness. Her only significant past medical was chronic pancreatitis. She was a non-smoker and did not drink alcohol. ECG revealed ischemic features and serum troponin I was postive at 1.8. Her plasma sodium was low at 125.

a. What is the probable cause of her chest pain ?
b. What risk factor could explain the low sodium ?
c. What is the immediate treatment?
d. Do her family require further screening ?


2. A 65-year-old man was treated for a myocardial infarction. 24 hours later, he became increasing hypotensive and oliguric. His chest was clear to auscultation. A central venous catheter was inserted and CVP was measured at 25cm H2O. The ECG reveal St segment elevation in the inferior leads, with a dominant R wave in V1.

a. Which artery is likely to be reponsible?
b. How do you explain the absence of pulmonary oedma despite an elevated CVP?
c. What is the immediate treatment?


3. A 78-year –old man was admitted following a collapse at home. He had suffered a myocardial infarction the previous year, which was complicated by complete heart block, ventricular fibrilliation and left ventricular failure. An implantable cardioverter defibrillato was inserted at the time. Shortly after admission he suffered a further collapse and a defibrillator shock was delivered. The telemetry print-out is ventricular tachycardia.

a. What is cause of the collapse ?
b. How should this patient be managed?
c. What is the prognosis ?

[oxford873]

second case answer
a.due to blockage of anterior coronary artery
B.there is no pulmonary edema because the left side of the heart is normal and there is no increasing in the venous pressure in the lung to case congestion and mostly pulmonary edema is due to left side heart failure so only there is failure of right side of the heart so that there will be only systemic increase in venous pressure not in the pulmonary circulation that s why the CVP is hight and also could be JVP raised during examination
c.because of oliguria most probably the patient had developed renal failure due to pre renal cause which is hypovolemia so the so the managment include treatment of mi and renal failure
c.