Bill, a 51-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 Bill to check into an emergency room. During the drive down a canyon with steep, winding curves, Bill collapsed.

On arrival at the emergency room, Bill was unconscious. His skin was cool, clammy, and very pale. His blood pres­sure was very low and his pulse was weak and irregular. Established resuscitation procedures were followed. After Bill’s return to consciousness, an electrocardiogram showed evidence of myocardial injury and blood was drawn to check en­zyme and electrolyte levels. When history was obtained, Bill stated he is a harassed advertising executive and denied sig­nificant illnesses. However, he is 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

Bill’s subsequent electrocardiograms and serum levels of CPK, LDH, and SGOT or AST verified anterior myocardial infarction.

Knowing the diagnosis, identify Bill’s risk factors, the early causes and precipitating events of his infarction, and the justification for using anticoagulant therapy?