Q1. Based on his presenting symptoms and observations what condition is Tom likely suffering?

Tom is likely suffering a Heart Attack. It happens when heart muscles are unable to get adequate oxygen supply due to blockage. The lack of oxygen supply causes chest pain (pressure or tightness) which could radiate to neck, jaw, arms and back. Coronary heart disease is the condition that blocks heart’s oxygen. The disease causes build-up of fatty acids and cholesterol in coronary arteries’ walls. The accumulation of these substances creates a plaque capable of breaking to cause blood clot, which blocks the arteries responsible for supplying oxygen. Narrowing of blood vessels caused by coronary artery spasm and sudden tearing of coronary artery wall may also cause heart attack but Tom’s situation relates closely with coronary heart disease. Hypercholesterolaemia or high cholesterol is a proof of this. This increases the chances of heart attack and stroke. Even more, PO Atorvastatin 20mg mane is medication for slowing cholesterol accumulation in artery walls as this could block blood flowing into brain, heart and other body parts. PO Perindopril 5mg mane, which Tom uses, is as well ACE inhibitor appropriate for treatment of heart failure or coronary artery disease.  

Q2. It is likely that Tom's symptoms are caused by problems with which body system?

Tom’s symptoms originate from problems with Respiratory System. The operations of human heart and lungs together, ensure that the body gets adequate supply of oxygen-rich blood. What happens is that heart’s right side takes the blood with less oxygen to the lungs for re-oxygenating and the left side carries blood to all parts of the body to ensure the needed oxygen is obtained. This means that issues with either heart or lungs can cause breathing problems. Arteries are responsible for moving blood from the heart through the entire body. In this systematic circulation, oxygenated blood flows into aorta. Two coronary arteries at the beginning of aorta form a network comprising small arteries that supply oxygen to the heart and nourish its muscles. In the case of coronary artery illness, atherosclerotic plaques (consisting of calcium, dead cells and fat deposits) occupy the coronary arteries’ inner walls and interrupt the smooth flow of blood. In cases where thrombus formation occurs, heart’s blood supply may be fully cut. This leads to a heart attack. These could be indicated by low oxygen, fatigue, shortness of breath, palpitations, and near fainting.

Q3.  In your own words, explain how oxygen is circulated to the body

When a person breathes, through either mouth or nose, air enters the windpipe. The air then enters airways which transport it to the lungs. Lungs filter the air to ensure that only oxygen gets into the body and ensure that the amount of oxygen allowed in is enough for daily body processes. From here, it enters tinier airs which lead it to air sacs. The air sacs contain paper-thin walls which allow oxygen to pass into small blood vessels known as capillaries. From here, oxygen enters the blood. In the red blood cells a protein, haemoglobin, circulates oxygen throughout the body.

Q4. Based on Tom’s admission vital signs, identify what vital signs are abnormal. Include the normal range for each abnormal observation you identify.

· The only normal vital sign of Tom at admission is body temperature.  

· Pulse rate of 120 beats per minute indicates less efficient heart health and lower cardiovascular fitness. The normal resting heart beat in adults lies between 60 and 100.

· The normal BP is 90/60mmHg to 120/80mmHg. Tom’s BP of 218/110 mmHg is, thus, high.

· Respirations are normal if per minute beats are 12 to 16. Therefore, 36 is way above the normal range.

SaO2 of 90% implies that Tom has lesser oxygen-saturated haemoglobin molecules within his arterial blood.

Q5. Given the abnormal vital signs and Tom’s symptoms, list 3 other health care providers (not including nurses) that you would ensure is involved in Tom’s immediate care, include a rationale for each referral.


A personal GP is important because they get to know a patient’s medical history. A GP, thus, knows the best medical services and hospitals for treatment of urgent cases or those that need the attention of professionals. A regular GP also helps a patient manage the common mental and physical symptoms. They are a crucial source of information on management of chronic conditions. Also, a GP offers advice on preventive activities to enable someone lead healthy lifestyle.  


This is a doctor with specialized knowledge on treatment of heart abnormalities and diseases. A cardiologist has more specialised knowledge and is thus capable of offering increasingly effective treatment. The continuous focus on heart problems also increase the knowledge of the practitioner and this leads to accurate diagnosis and treatment of illnesses.  


A pulmonologist specialises in lungs pathology, physiology and anatomy. The specialist is, therefore, capable of diagnosing, treating and managing the more sophisticated diseases that have primary effect on the lungs.  

Q5. In your own words, describe the pathophysiology of Myocardial Infarction?

Myocardial infarction or heart attack is the complete (irreversible) impairment of myocardial tissue due to lengthy hypoxia and ischemia. It happens when rapturing of atherosclerotic plaque blocks coronary artery, due to the resulting blood clot. The complete obstruction of vessels that supply myocardium makes it ischemic and hypoxic. Such tissue may eventually die of oxygen insufficiency. At the point of damage, the tissue contains a necrotic core within a marginal zone, which may regain normality or undergo irreversible destruction. 

Arrhythmias may be generated by the hypoxic tissue in the border zone. Infarct rate and reversibility of border zone is determined by collateral blood flow. Infarcted tissue has no role in tension production during systole and can, thus, interfere with ventricular systolic/diastolic operation and interfere with heart’s electrical activity. The tissue may create a fibrotic scar over weeks and undergo ventricular remodeling of the left myocardium in the long run. 

Other consequences include failure of ventricular, arrhythmias and unexplained demise. Myocardial infarctions come with signs such as severe chest pain, a feeling of substernal heaviness, pressure/squeezing, dyspnea, fainting or syncope, sweating, nausea, hypertension/hypotension, arrhythmias, and tachycardia. 

Q7. The doctor has prescribed Aspirin for Tom. Explain how this will assist Tom?

Other than pain relief and reducing fever or inflammation, aspirin has the ability to prevent clotting of blood. Blood clots are the primary reason for stroke and heart attacks. The clots result from the body’s attempt to control damage from rapturing of a plaque, and it blocks flow of blood to the heart/brain. A regular aspirin dose minimises the potential of blood clumps formation by targeting the platelets. He blood thinning effect of aspirin is what minimises chances of strokes and heart attacks.

Q8.  What are the risks associated with taking aspirin?

Aspirin, like other medicines, has side effects. It can cause ulcers, bleeding and gastrointestinal issues by irritating the stomach lining. Aspirin’s blood thinning effect may also expose individuals with increased risk of bleeding to more harm.

Q9. The doctors have performed a blood test which has a troponin result of 0.8 nanogram/mL. What is the significance of this result in Tom’s case?

The normal range for troponin is between 0 and 0.4 ng/ml having a result higher than normal indicate a problem with heart. Given that the test results exceed 0.4 ng/ml (at 0.8 ng/ml), this is an indication that Tom recently suffered a heart attack. The high troponin level means that the heart released more of this substance in response to the injury caused by the heart attack.

Q10. What lifestyle modifications would you recommend on Tom’s discharge home?

· Tom should select good nutrition. A healthy diet is crucial in prevention of cardiovascular disease. Proper diet can eliminate risk factors of heart attack such as cholesterol and blood pressure. The best foods are those with minerals, vitamins, fibre and lower calories.

· Apart from good food, physical exercises should be regular. Weekly engagement in moderate-intense physical activity lowers blood pressure, cholesterol and enables maintenance of a heathy weight.