What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"

Case study ( 3514 views as of November 18, 2018 )

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.

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Conversation based on: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"

What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"

  • Atrial fibrillation is an irregular heartbeat, also called an arrhythmia, that can increase your risk of heart failure, stroke, blood clots and other heart conditions. A normal heart contracts and relaxes to a regular beat, but if you have atrial fibrillation, the atria (upper chambers) beat out of sync with the ventricles (lower chambers). The irregular heartbeat can cause blood to pool in your atria, causing blood clots that travel to your brain and cause a stroke. Possible causes of atrial fibrillation include: • Previous heart attacks • High blood pressure • Congenital heart defects • Coronary artery disease • Viral infections • An overactive thyroid gland Some people with atrial fibrillation have no symptoms. Atrial fibrillation symptoms can include: • Heart palpitations • Shortness of breath • Dizziness • Fatigue • Chest pain Atrial fibrillation isn't usually life threatening, but it is a serious medical condition that requires treatment. If you experience atrial fibrillation symptoms, consult with your doctor. Your physician may recommend an electrocardiogram to diagnose your heart condition. The goal of atrial fibrillation treatment is to restore your normal heart rate and rhythm and prevent blood clots. Your treatment may include medications, electrical cardioversion, a pacemaker or surgery.
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  • I've heard that the symptoms of a heart attack are different for women than for men. What symptoms do women need to be watch out for ?
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    • Recently there has been a hashtag trending - HEPPP. Stands for Hot, Exhausted, Pain, Pale, Puke. Those are supposed to be the most common signs for women suffering a heart attack
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    • @K.Michael - heart attack symptoms in women can be more vague than the hallmark symptom of crushing chest pain that goes down into the arm. Women can experience pain in the arm, neck, jaw or even back. Women also may be more likely to have stomach pain if they are having a heart attack, as well as breaking out into a cold sweat. Fatigue is another complaint of women who are having a heart attack. As with any of these symptoms, it is best to call 911 and get assessed urgently to make sure your heart is ok.
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  • The case study indicates that Patrick is taking insulin. Does diabetes increase your risk of heart attack ?
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    • Yes, having diabetes significantly increases your risk of heart disease because of the damage high blood sugar does to blood vessels. For example, accumulated sugar can increase blood viscosity making it difficult to circulate, or blood vessels may become narrow as a result of fat deposits along the walls (again making blood difficult to circulate). Reduced blood flow to the heart is the key risk for heart attacks and other heart disease, so managing his diabetes and cholesterol is crucial for Patrick. Seeing a Registered Dietitian will be a very important part of his treatment plan in order to work towards this.
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  • In addition to the doctors suggested he might also want to speak to a counselor after his angioplasty procedure. Having a heart attack can create mental, as well as physical, issues
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  • What a shock to be awoken out of a sleep with chest pains and then within minutes be taken by an ambulance to have surgery. Good for him for asking such great questions before signing the consent form. I'm not sure I would be able to do that-I would still be in shock that I was having a heart attack and about to go into surgery!
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  • Seeing a nutritionist to get a healthy heart diet is a good idea. This video on Health Choices First has some more "Heart Disease Prevention Strategies". What did you think of the video?
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    • I liked the video and found it quite informative about the Healthy Heart diet
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    • Healthy Heart diet is a good one for anyone to follow, not just those who have had heart attacks or are at an increased risk for one.
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  • How to baby aspirins aid the person when having a heart attack ? Is this a common treatment for heart attacks ?
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    • I've heard the advice to chew two baby aspirin if you think you are having a heart attack but didn't think it was something that was readily available
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  • If you suspect a heart attack is it best to see a cardiologist to obtain an ECG to find out what is going on with your body or can a GP follow your symptoms/diagnosis ?
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  • My husband had a heart attack scare several years ago. It was explained to him that contrary to popular perception, a heart attack may not be sudden but rather a dull, sustained pain radiating along the left side.
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    • Very true. It's important to talk to your physician or other health professional to learn all the signs of a heart attack if this is something that you or a loved one are at risk of.
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  • What are the dangers / advantages of having the angioplasty now vs later ?
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    • I am also interested, Michelle. Wouldn't the paramedics triage someone with a suspected heart attack and make sure that the individual gets the appropriate care once they arrive at the hospital?
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    • That's a very interesting observation Michelle. Would the ambulance not take you to the hospital best suited to your condition - provided you are stable and can safely wait the additional travel time ?
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    • The angioplasty needs to be done in this case on an emergency basis, so if this patient does not have the procedure he will run the risk of more significant cardiac events. It is really helpful when you think you are having a heart attack or stroke to try and get to a hospital that has the ability for emergency procedures like this as it can prevent valuable time from being wasted (especially in the case of a stroke patient).
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