EMT's arrive with H.H., a 74-year old naked male who is suffering a possible myocardial infarction (MI). Patent experienced internse chest pains, shortness of breath (dyspnea), profuse sweating, and nausea while at home with his new (and very young) wife. You are a new resident working under Dr. Home and Dr. Home insists you tend to him. Physical Exam: Average body trame. Height = 510: Weight = 225 pounds Heart Rate = 102 bpm (normal = 70 bpmk Blood pressure = 150/110 mm Hg Respiration rate = 24 breathsimin (normal = 12-18 breathalmin) History H.H. has hypertension, which he treats sporadicaly with beta-blockers. EKG for H.H. ST-depression Blood Tests for H.H. Cardiac Troponin i |Cardiac Troponin I (CTni) 1. What is your initiai diagnosis for the cause of H.H.'s condinion? Pravide evidence from the pationt's physical exam, EKG, and blood tests to support your diagnosis. 2. How could untreated hypertension contribute to H.H.'s condition? Patient H.H. values 52 ngim Normal values C0.1 ngml As a first-line treatment for H.H's condtion, you administer nitroglycerine. 3. Why is nitroglycerin given as a treatment for myocardial intarction? What does it do to blood vessels and blood pressure? How doas it heip the heart tissue? Shortly after administering the nitroglycerine, the HH. becomes unresponsive. Dr. Home quickly evaluates the situation and demands to know whether you discussed the patient's histary with the EMTS prior to administering nitroglycerin. You are forced to admit that you had not received a ful report. He asks the EMTS about possible Viagra use and one of the EMT's confirms that a botte of Viagra was on the bedside when they arived at the patient's house. 4. What aftect does Vagra have on blood vessels and blood pressure? 5. What effect could the combination of nitroglycerin and Viagra have on blood vessels and blood pressure? Why could this be life threatoning? 6. Why did Dr. Home start fluid resuscitation and give phenylephrine to treat the pationt's condition?