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):

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 heart attack and myocardial infarction?

5) What is TPA? Explain how it relieves the chest pain and how it improves the survival rate in a patient with acute myocardial infarction.

Answer 1

1. The possible reason for John's chest pain would be due to atrial fibrillation. This is a quick and uneven heart rate which causes heart failure and stroke.

2. As it is an acute chest pain, it includes gastroesophageal, muscukoskeletal, cardiac and pulmonary conditions. This is because of acute pain. It is important to diagnose a cardiac etiology in patients having acute chest pain.

3. The team mates of John has taken him and rushed to hospital due to the severe pain in chest.They have made all arrangement to get diagnosed. Doctors have diagnoses the problem by doing different tests.

4. Heart attack occurs when coronary artery becomes blocked which thereby stops the flow of blood to heart. A part of the heart or all parts will be cut off from its oxygen supply.

Myocardial infraction occurs when blood flow decreases or stops to a particular part of heart which causes damage to heart muscle.

5. TPA is nothing but tissue plasminogen activator. It is also called fibrinolytic therapy and restores coronary patency and significantly reduces mortality. Intravenous beta blockers and ACE inhibitors are beneficial in acute myocardial infraction.

The main aim of treatment is to reduce mortality and restore the flow using drug therapy fibrinolytic agents, anti thrombins and anti platelet agents.

Recently coronary angioplasty has been introduced to restore flow mechanically.

The speed at which the flow is restored very important . For every hour of delay, the therapy effect decreases and there by the mortality increases.