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A collapsed 60 year old bus driver was brought to casualty complaining of severe sustained crushing pain in a band across his chest spreading into the left arm. He had been well but smokes 10 cigarette perhaps. on chest examination he was pale with cold sweaty skin his pulse was weak with occasional ventricular ectopis.

His arterial pressure 95/70mmHg,heart sounds normal. An ECG revealed large Q wave and St segment elevated.

a) What was the likely coronary artery pathology and how does endothelial damage contribute to it.

b) If the patients arterial blood contained 190mlO2/l mixed venous blood 90mlO2/l and his O2 consumption 300ml/min. What is the cardiac output. What is the principle used.

c) What made skin pale cold and sweaty

d) What caused the ST segment displacement.

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