ACUTE

MYOCARDIAL
INFARCTION (AMI)

Health History
The subject of the case study is PM.
Patient PM is a 76 year old female who
was admitted to Jose R. Reyes Memorial
Medical Center (JRRMMC) on October 19,
2013. PM was diagnosed to have an acute
Myocardial Infarction (AMI). This disorder is
amedical term for an event commonly
known as aheart attack.

Acute Myocardial Infarction

(AMI)
AMI happens whenbloodstops flowing
properly to part of the heart and theheart
muscleis injured due to not enough
oxygen. Usually this is because one of
thecoronary arteriesthat supplies blood to
the heart develops a blockage due to
anunstable
buildupofwhite
blood
cells,cholesterol and fat. The event is
called "acute" if it is sudden and serious.
Some causes of AMI are as follows:
hyperlipidemia,
diabetes
mellitus,
hypertension, tobacco use, and family
history of atherosclerotic arterial disease.

Diagnostic Measure
On October 20, 2013. P. M. under went several diagnostic
studies in order to confirm that she indeed had suffered a
heart attack. Her physician requested for qualitative
Troponin I test and LDH determination.

A Troponin test is often the first test that emergency

rooms use because the protein appears early, giving
physicians a clue to whether a heart attack is occurring
while LDH is a cardiac marker that will begin to rise 2 to 5
days after an MI; the elevation can last 10 days. LDH is an
enzyme released in the blood with cell injury. It is used as
a late marker to detect a heart attack.
The test revealed a positive troponin test and an LDH
value of 676.90 mmol/l. This indicates a positive AMI
occurrence since the normal value of LDH is 0-250 mmol/l.
Other cardiac markes that could have help in diagnosing
AMI are: CK-MB, and Myoglobin determination.

Cardiac Markers
Test

Cardiac
Marker start
to Increase

Reaches
Peak Level

CK-MB

3-4 hours

12-24h ours

Myoglobi
n

1-2 hours

4-6 hours

24 hours

Troponin

3-6 hours

12-24

1 week

24-48 hours

3-4 days

5-10 days

LDH

Duration

Enzyme
from

48-72 hours Heart

Heart,
Skeletal
Muscle
Heart
Heart,
Lungs,
Kidney,
Muscle,
Liver

Diagnostic Measure
Following the previous test of the patient, her
physician requested for another laboratory
test to determine what caused the heart
attack. The following test requested were:
FBS
HBA1c
Lipid Profile (Chole, TAG, HDL, LDL)
This test will help determine whether
the
patient
suffered
AMI
due
to
Hyperlipidemia or Diabetes Mellitus, which
are the most common risk-factor of AMI.

Diagnostic Measure
TEST

RESULT

NORMAL
VALUE

FBS

6.55 mmol/l

4.11-5.89
mmol/

HBA1c

6.46 %

4.8-5.9 %

Cholesterol

4.33 mmol/l

0-5.2 mmol/l

Triglyceride

0.63 mmol/l

0-2.3 mmol/l

LDL

1.83 mmol/l

0-2.59 mmol/l

HDL indicates that

1.01 mmol/l
mmol/l
This
the patient1.83
had
an AMI due to
Diabetes Mellitus. Patients with diabetes have a substantially
greater risk of atherosclerotic vascular disease in the heart as
well as in other vascular beds. Diabetes increases the risk of
MI because it increases the rate of atherosclerotic progression
and adversely affects the lipid profile. This accelerated form of
atherosclerosis occurs regardless of whether a patient has
insulin-dependent or noninsulin-dependent diabetes.