Maria is a 67-year-old retired, obese woman,

Maria is a 67-year-old retired, obese woman, who lives with her husband Max. She enjoys sitting down to a movie every night with a bottle of Shiraz and a large packet of salt and vinegar chips or tub of cookies and cream ice cream. Maria doesn’t like to exercise, particularly since she gets chest pain upon exertion. Maria’s father passed away from a heart attack at the age of 60. Maria’s mother has type II diabetes and hypertension, which she controls with medications. Maria has noticed that her chest pain has become more frequent and is lasting for a longer period of time. More recently, it has been occurring while she is watching television in the evening or whilst reading her book in bed. She decides to make an appointment with her GP for later in the week. At the medical clinic, the GP looks at Maria’s medical history. She was diagnosed with hypertension four years ago, for which she was put on an ACE inhibitor. The GP worries about Maria’s latest symptoms so writes a referral for her to see a cardiovascular specialist for an ECG and a coronary angiogram to determine why Maria has been short of breath and unwell. One day, whilst waiting for her results, Maria starts to feel more nauseous and dizzier than usual. She starts to feel clammy and sweaty, and her face seems grey in colour. The chest pain returns, but now feels like a crushing pain, and she can’t breathe. Her husband, Max, dials 000, and she is rushed to hospital. An ECG shows that Maria has ST elevation, and a blood test indicates that she has high levels of myocardium-specific troponin in her blood. Maria is given heparin intravenously as well as aspirin and tissue plasminogen activator. She is taken into surgery, where a coronary angioplasty is performed. Question 1 Before her current problems, Maria was prescribed with an ACE inhibitor for her hypertension. Explain the benefits of ACE inhibitor administration in the treatment of hypertension with specific emphasis on how this treatment reduces blood pressure. Question 2 Maria noticed that ‘her chest pain has become more frequent and is lasting for a longer period of time…’ Name the condition Maria was most likely experiencing and explain its pathogenesis. Question 3 Considering her clinical symptoms and laboratory findings, name the condition Maria is suffering from when admitted to the hospital and explain the benefits of tissue plasminogen activator administration in her present state.

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