Question

John, an overweight 49- year-old man with history of diabetes and hypertension is playing soccer After half an hour of an intense game, he feels severe chest pain that travels to his lower jaw. He is pale, diaphoretic, and short in breath. Upon arrival to the ER, an ECG was taken and the results show the following (note the changes in leads II, III and aVF): Choose 3 out of the 4 prompts and answer: 1. What could be the possible reason for John's chest pain? Explain your answer based on the clinical information. 2. How do you know John's chest pain is heart related? How do you rule out other etiologies of chest pain such as musculoskeletal, pneumonia, and gastric sources? 3. What actions should John's teammates have taken at the scene to help him? 4. How do you differentiate between cardiac arrest and myocardial infarction?

Answer 1

1. The tracing of ECG in II, III aVf leads shows severe ST elevation and this suggests inferior wall MI.

The chest pain felt after a strenuous work and which is referring towards the lower jaw, plus shortness of breath, diaphoresis and paleness are classic symptoms of Myocardial infarction.

2. The cardiac related chest pain usually develops as retrosternal pain , with a severe type . also the pain is explained as squeezing, or pressurizing the chest. It can occur in shoulders, arms, neck, jaw, or back.

The Pain that gets better or worse when you change your body position , the Pain that intensifies when you breathe deeply or cough and the tenderness when you push on your chest are mostly musculoskeletal pains.

The gastric pain can be usually in the epigastric area, and a sour taste or a sensation of food re-entering your mouth can be felt.

Pneumonic pains are usually sharp, but cardiac pains are not sharp type.

4. Due to inadequate blood flow to an area in the heart, the damage of that part occurs and this is called heart attack or Myocardial infarction.

The electrical system of the heart malfunctions , causing irregular beats and stopping the heart altogether is called Cardiac arrest.