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 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 myocardial ischemia 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.   

Answer 1

The possible reasons for John's chest pain are

• Overweight
• Age
• Diabetes

The clinical information like chest pain radiating to lower jaw, paleness, diaphoresis, short of breath indicates the problem is related to heart

The other etiology for chest pain can be because of intense exercise

John's teammate should do the following

• Ensure to calm him
• Providing good ventilation for oxygenation
• Meanwhile inform healthcare team or emergency services
• If oxygen available immediately administer
• Shift to hospital

In myocardial ischemia there is lack of oxygen supply to heart muscle due to blocked blood supply .In myocardial infarction the cells dies because if this and is irreversible .In ischemia the ECG changes are in U wave , inverted V4,V6

In infarction changes can be observed in lead II, III and aVf

TPA refers to tissue plasminogen activator which used to prevent the formation of thrombus and can breaks any blood clots and thus prevent heart attack .Oncw when the clot is thrombolyses the blood flow increases and decreased sensation of chest pain or relief of symptoms

It can greatly improve the survival rate .The death is controlled by 28% after administration of this drug for five years and increases survival rate by 37% in next ten years.