Question

J.V., a 56-year-old delivery truck driver, has been taken to the emergency department (ED) because he was experiencing chest pain. It started just after he had a quick lunch at a food truck. He told the paramedic that he often has chest pain but that it goes away when he "takes a swig of antacid," but this time the pain did not stop. On arrival he was given another dose of antacid and sublingual nitroglycerin, and the chest pain stopped. The first set of cardiac enzymes and basic metabolic profile (BMP) were drawn, and a 12-lead ECG was done. He weighs 275 pounds (125 kg), is 5 ft, 5 inches (165 cm) tall, and tells the nurse he has been overweight all his life. He said he'd had the chest pains for about 2 years but did not go to get checked because they always went away when he took antacids and he was too busy with work to go to a doctor. He works late hours, "lives on coffee," and grabs fast food when he has time to eat. He smokes 1.5 to 2 packs of cigarettes a day, has a beer every evening once he is home, and usually finishes a 6 pack on the weekends. Vital signs: T 98.9o F (37.2o C), P 110, R 14, BP 148/98. The test results are listed below.

TEST RESULTS

Sodium: 142 mEq/L (142 mmol/L)     Potassium: 4.1 mEq/L (4.1 mmol/L)

Chloride: 102 mEq/L (102 mmol/L)     CO2: 28 mEq/L (28 mmol/L)

Glucose: 168 mg/dL (9.3 mmol/L)     BUN: 12 mg/dL (4.3 mmol/L)

Creatinine: 1.1 mg/dL (97 mcmol/L)     Calcium: 5.1 mg/dL (1.28 mmol/L)

Hemoglobin: 14.8 g/dL (148 g/L)     Hematocrit: 48%

Cardiac troponin T: 0.05 ng/mL (0.05 mcg/L)     12-Lead ECG: Sinus tachycardia, rate 105

Six hours later, the second set of cardiac enzymes was normal. Do you think J.V. has had a myocardial infarction (MI)? Defend your answer.

Answer 1

J.V., a 56-year-old delivery truck driver, has been taken to the emergency department (ED) because he was experiencing chest pain.

It is a clear sign of a Myocardial infarction because

1. Chest pain stops after sublingual nitroglycerin administration.

2. J.V has almost all the risk factors of MI

he is Overweight (125 KG)

He works late hours, "lives on coffee,"

He ate fast food when he has time to eat.

  He smokes 1.5 to 2 packs of cigarettes a day

He drinks beer every day

He is hypertensive (148/98)

3. He had an MI but it is too old now so, cardiac enzymes were normal. cardiac enzymes become normal after 2 weeks of MI.

4. He had an MI but the pain was not so, intense because he is having Diabetes (Glucose 168 mg/dl), In Diabetes silent attacks happen due to nerve damage.