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 5 prompts and answer:
- What could be the possible reason for John’s chest pain? Explain your answer based on the clinical information.
- 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? - What actions should John’s teammates have taken at the scene to help him?
- How do you differentiate between heart attack and myocardial infarction?
- What is TPA? Explain how it relieves the chest pain and how it
improves the survival rate in a patient with acute myocardial
infarction.
Expert Solution Preview
Introduction:
The case presented is about a patient named John, who experienced chest pain while playing soccer. As a medical professor responsible for designing assignments and evaluating the performance of medical college students, the prompts provided are pivotal in assessing their clinical knowledge and understanding of the given scenario.
1. What could be the possible reason for John’s chest pain? Explain your answer based on the clinical information.
Based on the clinical information provided, the possible reason for John’s chest pain could be myocardial infarction or a heart attack. The chest pain that he experienced was severe, radiating to his lower jaw, accompanied by diaphoresis and shortness of breath. These symptoms are typical of myocardial infarction or a heart attack. Moreover, the ECG findings showing changes in leads II, III, and aVF support the diagnosis.
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?
John’s chest pain is heart-related because of the presenting symptoms, which are typical of myocardial infarction or heart attack. Further, the ECG findings indicate myocardial ischemia, suggesting blockage in a coronary artery. To rule out other etiologies of chest pain such as musculoskeletal, pneumonia, and gastric sources, additional clinical investigations, such as chest x-ray, blood tests, CT scan, and echocardiography, would be necessary.
3. What actions should John’s teammates have taken at the scene to help him?
John’s teammates should have immediately called for emergency medical services (EMS), put him in a semi-sitting position, and given him chewable aspirin. They should have checked his breathing, pulse, and level of consciousness while waiting for the EMS to arrive. In case John’s heart stops beating, the teammates should have been trained to perform cardiopulmonary resuscitation (CPR) until advanced help is available.
4. How do you differentiate between heart attack and myocardial infarction?
A heart attack and myocardial infarction (MI) are often used interchangeably, but a heart attack can occur due to blockage in the coronary artery, whereas MI refers to ischemic heart damage as a result of prolonged blockage in the coronary artery. Therefore, heart attack can be an umbrella term that includes both MI and other cardiac conditions.
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.
TPA or tissue plasminogen activator is a thrombolytic agent used to dissolve blood clots in the arteries, thus restoring blood flow. It relieves the chest pain by dissolving the blockage responsible for the MI. TPA is time-sensitive, and the earlier it is administered to a patient with acute MI, the better their chance of survival. Speedy intervention with TPA within 30 minutes to 6 hours after the onset of chest pain improves survival rates, reduces cardiac damage, and preserves cardiac function.
