What does Mr Smith’s ECG tell us about underlying cause of his conditionand howshould this be treated? How does this differ from a similar presentation without the S-T elevation?

BaP 2 assignment 3: Management of Cardiovascular Event(500 words max)Mr. Smithis a 56-year-old white man who began to experience chest discomfort while playing football. The discomfort intensified to a crushing sensation in the sternal area and the pain spread upward into his neck and lower jaw. The pain was not relieved by his GTN spray. An ambulance was called and Mr. Smithwas takento hospital arriving within 30 minutes of the onset of his chest pain. Ambulance paramedic administered aspirin (tablet, 300 mg oral) and 2 mg IV morphine. On arrival at hospital his pain has eased slightly but is still significant; was 9/10 in severity; now 7/10. Vital signs on admission: Blood pressure: 160/98mmHg; Respiratory rate: 27breaths per minute; Pulse 118bpm; Temperature 38.2oC; arterial oxygen saturation94%Electrocardiogram; 4 mm ST segment elevation in leads V2–V6Past medical history: Hypertension; 12 years (poorly controlled due to poor patient compliance). Type 2diabetes mellitus for5 years; Stable angina for the past 4 years; Hyperlipidaemiadiagnosed 5 years previously. Family history: Father died from myocardial infarction at age 55, had 2 diabetes mellitus; Mother died from breast cancer at age 79; Patient has one sister, age 52, who is alive and well and one brother, age 44, who hashypertension. He has noallergiesPresent medications: Simvastatin, 40 mg once daily; NifedipineMR (Adalat LA), 60 mg once daily; GTN spray, 1-2 puffs sublingual as required; Metformin2x 500 mg oncedaily.

1.What condition is Mr Smith’s presently experiencingand what is the underlying cause of this condition (briefly outline the underlying pathophysiology).20%

2.Outline the immediate (on arrival) aim of treatment for Mr Smithand where relevant, describe any recommendations for drug managementand investigations. 30%

3.What does Mr Smith’s ECG tell us about underlying cause of his conditionand howshould this be treated? How does this differ from a similar presentation without the S-T elevation?20%

4.What medication would you expect to seeon Mr Smith’sdischarge prescription? Justify your answer20%

5.For the discharge medication, what counselling points would be discussed with Mr Smith? 10%N.B Standard front pageto be included. Correctly formatted references from creditablesources to cited.