jean robert
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A 62 y.o African American woman is brought to ER with acute chest pain. She also complains of perspiration,nausea and lightheadedness. Her BP is 90/60 mmHg and her HR is 42 bpm.An ECG reveals ST segment elevation in the inferior leads.After initial treatment her BP is 120/70 mmHg and HR is 76bpm.She now complains of severe right sided eye pain. Which of the following is the most likely eye problem in this patient?
a) Iridocyclitis
b) Retinal artery trombosis
c) Acute conjunctivitis
d) Cataract
e) Glaucoma
f) Retinal detachment
g) Retinal vein thrombosis
h) Vitreous hemorrhage
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| peraspera
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Glaucoma
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| arlete
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H: Side effect of thrombolitic therapy for MI.
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| silver
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isn't vitreous hemorrhage painless
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| me007
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initial treatment supposed to incr BP and HR -
in setting of aqute eye pain - likely that she got beta-agonist which normalized cardiovascular disturbances and precipitated glaucoma.
but with this explanation not too clear with elevated ST.
vitreous hemorrhage not likely - impaired vision is a symptom.
and actually not a side effect of thrombolytic therapy.
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| silver
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me007,
how can beta-agonist precipitate glaucoma? the eye doesn't have any beta receptors, it's all alpha
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| new_n_lost
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It does kinda make sense that the precipitation of her Narrow Angle Glacoma cud be the reason for her very painful eye but the B agonist r not Effect Eye cos they have no receptors there . and the only condition to cause severe pain is Glaucoma. Mech is beyond me
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| me007
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silver wrote:
me007,
how can beta-agonist precipitate glaucoma? the eye doesn't have any beta receptors, it's all alpha
isn't beta-blockers used to treat glaucoma?
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| silver
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yes, beta-blocker can be used in treatment of glaucoma (timolol--given topically), you wrote beta-agonist.
the mainstay of glaucoma treatment is prostaglandins, alpha-agonists, and cholinomimetics. beta-blocker treatment isn't part of the main treatment.
plus, this patient came with chest pain who later on developed ocular symptoms..so whatever lead to that has to be an agent used in the treatment of MI.
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| me007
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silver wrote:
yes, beta-blocker can be used in treatment of glaucoma (timolol--given topically), you wrote beta-agonist.
the mainstay of glaucoma treatment is prostaglandins, alpha-agonists, and cholinomimetics. beta-blocker treatment isn't part of the main treatment.
plus, this patient came with chest pain who later on developed ocular symptoms..so whatever lead to that has to be an agent used in the treatment of MI.
yes, beta agonist - to incr BP and HR
bcs beta-antagonists will decrease her HR
should be explanation for this 
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| me007
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retinal artery thrombosis is painless, and visual symptoms should be present.
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| silver
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i'm interested in seeing what expln. UW gives for this ques.
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| arlete
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Beta agonist used for MI? Do you have a reference for that?
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| me007
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i'm looking for something what rased BP - both syst ans diast, increased HR and precipitated glaucoma.
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| arlete
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Atropin, maybe?
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| me007
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arlete wrote:Atropin, maybe?
genious
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| arlete
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I hope we nailed it!
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| arlete
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Silver:
You are right, it is painless (I did not know, sorry...)
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| jean robert
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Glaucoma is the correct answer.
Acute Closed angle glaucoma presents with Unilateral severe eye Pain.
EXPLANATION.
We all agree that this patient suffers a MI,specifically INFERIOR MI ( ST segment elevation.)
It s known that Inferior MI is often due to Blockage of of the RIGHT CORONARY ARTERY, the artery responsible for SA node perfusion ..........Bradicardia
To correct the bradicardia, The patient was given Atropine, which increase HR by blocking Vagal influence on the SA node.
On the other hand ,through the muscarinic receptors Atropine causes mydriasis resulting in a narrowing of the anterior chamber and decrease outflow of aqueous humor.
This can precipitate Glaucoma in patient with increased Intraocular pressure.
African American woman are at increased risk of glaucoma.
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| jean robert
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African american in general ( not only women)
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