Mr. Robertson, a 48-year-old white male, was assisting in the launching of his best friend’s water ski boat from a faulty boat trailer when he began to experience chest discomfort. At first, he believed his discomfort was because of the extreme July heat. Gradually, the discomfort became a crushing pain in his sternal area that radiated into his left arm and lower jaw. His friend suspected an ensuing heart attack and convinced Mr. R. to check into an emergency room. During the drive down a canyon with steep, winding curves, Mr. R. collapsed.

On arrival at the emergency room, Mr. Robertson was unconscious. His skin was cool, clammy, and very pale. His blood pressure was so low that it had to be palpated, and his pulse was weak but regular. Established resuscitation procedures were followed. After his return to consciousness, an electrocardiogram showed evidence of anterior myocardial injury, and blood was drawn to check enzyme and electrolyte levels. When history could be obtained, Mr. R. stated that he was a harassed advertising executive and denied significant illnesses. However, he was being treated for primary hypertension. He acknowledged smoking three packs of cigarettes a day for 30 years. His father died of a heart attack at the age of 47.

Mr. Robertson’s subsequent electrocardiograms and serum levels of myocardium infarction indicators confirmed myocardial infarction. Also, the area of infarction was in the anterior myocardium.

Discuss the pathophysiological changes that occur with myocardial infarction.

What factors from Mr. R’s history could be contributing factors for myocardial infarction?

Give a justification for the use of anticoagulant therapy for this patient.

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