Case study ( 3810 views as of March 25, 2019 )
Patrick is a 70-year-old diabetic man with a 2-year history of stable chest pain when he exerts himself. He is awoken from sleep with the acute onset of crushing central chest pain which radiates to his neck and left arm. His normal medications include normally aspirin, a diuretic, a cholesterol-lowering pill and insulin. He is mildly short of breath and also starts sweating profusely. He takes two Tums which fail to relieve his symptoms and his wife calls 911. The ambulance comes within 10 minutes of the 911 call and they perform an in-field ECG. The automatic ECG interpretation reads "Acute anterior wall ST elevation myocardial infarction". The ambulance attendant tells him that he is having a large heart attack which is potentially life-threatening and is being caused by an acute blockage of a major coronary artery by a blood clot that had formed on top of an unstable blockage of cholesterol.
Patrick is given 2 baby aspirins to chew and swallow and is immediately transported to the nearest hospital for treatment. He is told that the hospital he is going to has the capability of performing primary percutaneous coronary intervention (PPCI), otherwise known as emergency angioplasty and stunting.
He has several questions prior to signing his consent form for the procedure, including the risk of the heart attack to his life, the treatment options available to him, and the long term outcomes as a consequence of his heart attack. He also wants to know what will happen to him after he leaves the hospital and what his prognosis will be.
Patrick would benefit from seeing a cardiologist on a regular basis as well as being involved in a healthy heart program which is often offered through hospitals. He may also benefit from seeing a dietitian to see if he can lower his cholesterol levels through diet. After he is treated and on his way to recovery, he may wish to start a cardiac rehab exercise program to gain back his strength.Author: Dr. Graham Wong, VGH