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What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"

Case study ( 13101 views as of November 23, 2024 )

Patrick is a 70-year-old diabetic man with a 2-year history of stable chest pain when he exerts himself. He is awoken from sleep with the acute onset of crushing central chest pain which radiates to his neck and left arm. His normal medications include normally aspirin, a diuretic, a cholesterol-lowering pill and insulin. He is mildly short of breath and also starts sweating profusely. He takes two Tums which fail to relieve his symptoms and his wife calls 911. The ambulance comes within 10 minutes of the 911 call and they perform an in-field ECG. The automatic ECG interpretation reads "Acute anterior wall ST elevation myocardial infarction". The ambulance attendant tells him that he is having a large heart attack which is potentially life-threatening and is being caused by an acute blockage of a major coronary artery by a blood clot that had formed on top of an unstable blockage of cholesterol.

Patrick is given 2 baby aspirins to chew and swallow and is immediately transported to the nearest hospital for treatment. He is told that the hospital he is going to has the capability of performing primary percutaneous coronary intervention (PPCI), otherwise known as emergency angioplasty and stunting.

He has several questions prior to signing his consent form for the procedure, including the risk of the heart attack to his life, the treatment options available to him, and the long term outcomes as a consequence of his heart attack. He also wants to know what will happen to him after he leaves the hospital and what his prognosis will be.

Patrick would benefit from seeing a cardiologist on a regular basis as well as being involved in a healthy heart program which is often offered through hospitals. He may also benefit from seeing a dietitian to see if he can lower his cholesterol levels through diet. After he is treated and on his way to recovery, he may wish to start a cardiac rehab exercise program to gain back his strength.

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Conversation based on: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"

What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"

  • Dr. Graham Wong MPH, FRCPC
    Dr. Graham Wong MPH, FRCPC Cardiologist, Vancouver, BC 28 August 2019
    A Comprehensive Guide on Heart Failure Congestive heart failure (often called heart failure) is a chronic heart condition that occurs when your heart muscle is ineffective at pumping blood. As a result, your body hangs on to salt and water, causing your heart to beat faster and potentially get bigger. Heart failure may be a chronic condition (ongoing) or acute (occur suddenly). Certain conditions such as high blood pressure, diabetes and coronary artery disease can lead to congestive heart failure. There are a number of treatments for heart failure, and lifestyle changes can help improve your quality of life. Causes of Heart Failure There are a number of conditions that can lead to heart failure; it is most often related to another disease or illness such as: Coronary artery disease. This is the most common cause of heart failure. A previous heart attack resulting from coronary artery disease. High blood pressure. If your heart has to work harder to circulate blood throughout your body, it can make your heart muscle weak or stiff. Diabetes. There is a link between diabetes and heart failure. Cardiomyopathy. Diseases, infections or abuse of alcohol/drugs can cause this condition. Lifestyle factors can increase your risk of heart failure, including smoking, excessive alcohol use and physical inactivity. Type of Heart Failure There are four types of heart failure: Left-sided heart failure, which causes fluid to back up in the lungs. Right-sided heart failure, which causes fluid to back up into your abdomen, feet and legs. Systolic heart failure, which is a pumping problem in the left ventricle. Diastolic heart failure, which is a filling problem in the left ventricle. Symptoms of Heart Failure It’s important to see your healthcare provider for regular checkups, and especially if you're experiencing symptoms of heart failure, which can include: Shortness of breath, especially when you exercise or lie down Chest pain Fatigue Nausea Irregular or rapid heartbeat Weakness Edema (swelling) in your feet, ankles, legs or abdomen Wheezing or cough Lack of appetite Difficulty concentrating Pink-tinged mucus or phlegm Risk Factors for Heart Failure There are many different risk factors for heart failure, including: Coronary artery disease High blood pressure Diabetes and some diabetes medications Heart attack Obesity Viruses Sleep apnea Certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) Alcohol or drug use Congenital heart defects Smoking There are also complications that can occur as a result of heart failure, including: Heart valve or heart rhythm problems Liver damage from a buildup of fluid that puts pressure on the liver and causes scarring Kidney damage, due to reduced blood flow to the kidneys How to Prevent Heart Failure The best way to prevent heart failure is to make healthy lifestyle changes. This reduces your risk factors. In addition, see your physician regularly and take all medications as prescribed. Some of the lifestyle changes that can prevent heart failure include: Quitting smoking Abstaining from alcohol or limiting your intake Eating a healthy low-fat, low-sodium diet Maintaining a healthy weight Getting regular exercise Effectively managing other conditions such as coronary artery disease and high blood pressure Diagnosing Heart Failure To diagnose heart failure, your physician will perform a physical exam to look for things like congested lungs or fluid buildup. He or she will review your medical history and you’ll have a chance to discuss your symptoms. If your physician thinks you should undergo further testing, he or she may order: Blood tests. This may show conditions that can affect the heart and a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP). X-rays. An X-ray image of your chest can show the condition of your heart and lungs. Echocardiogram. This test produces a video image of your heart, which can show abnormalities and measure how well your heart is pumping. Electrocardiogram (ECG or EKG). Your doctor will attach electrodes to your skin to record the electrical activity of your heart. Cardiac computerized tomography (CT) scan. This machine collects images of your chest and heart while you lie on a table. Magnetic resonance imaging (MRI). This machine produces a magnetic field to create images of your heart. Coronary angiogram. The doctor will insert a thin catheter into a blood vessel (groin or arm), and then guide it into your coronary arteries. Dye is injected into the catheter so that your physician can visualize blockages. Stress tests. Usually, you’ll walk on a treadmill while attached to an ECG machine to measure the effects of exertion on your heart. Treatment of Heart Failure Treatment of your heart failure depends on the type and severity. It’s important to remember that there is no cure for heart failure, but treatment can improve your symptoms and strengthen your heart. There are three main types of treatment for heart failure: medications, devices and surgery. Generally, physicians will prescribe a combination of medications to treat your condition, including: ACE (angiotensin-converting enzyme) inhibitors. These drugs are a type of vasodilator, which lower blood pressure and improve blood flow. By widening the blood vessels, ACE inhibitors help you feel better, as there is less stress on the heart. Aldosterone antagonists. Also known as potassium-sparing diuretics, these are often prescribed for patients with severe heart failure symptoms. Angiotensin II receptor blockers. These drugs are often used as an alternative for patients who can’t tolerate ACE inhibitors; they have many of the same benefits. Beta blockers. Another common medication for heart failure, beta blockers reduce blood pressure and slow your heart rate; they may even reverse some heart damage. Digoxin. Also known as digitalis, this medication is used to slow the heartbeat and increase reduce heart failure symptoms. Diuretics (water pills). These are prescribed to prevent you from retaining fluid, which can reduce edema. You’ll probably have to take potassium and magnesium supplements if you take diuretics. Nitrates. These can help reduce chest pain. Statins. You may take statins to lower cholesterol. Some of the devices used to treat heart failure include: Biventricular pacing (also known as cardiac resynchronization therapy). This type of pacemaker sends timed electrical impulses to the heart, improving pumping. This treatment may be combined with an ICD. ICDs (implantable cardioverter-defibrillators). Similar to a pacemaker, an ICD is implanted in your chest, and its wires lead through your veins and into your heart. If your heart stops or begins beating too irregularly, the ICD will get it back into a normal rhythm. Oxygen tanks. Patients with severe heart failure may need to use supplemental oxygen on a regular, long-term basis. VADs (ventricular assist devices). A mechanical pump is implanted into your chest or abdomen to help pump blood from your heart to the rest of your body. These may be used in patients waiting for a heart transplant. If you need surgery to treat heart failure, you may undergo: Coronary bypass surgery. The cardiothoracic surgeon will take blood vessels from your leg, arm or chest to bypass a blocked artery in your heart. Following coronary bypass surgery, blood should flow more freely through your heart. Heart valve repair (or replacement). If you have a faulty heart valve, you may need heart valve repair; if it’s more severe, you may require valve replacement surgery. Heart transplant. If medications, devices or surgery doesn’t help, you may need to have a heart transplant. When Should I Call a Doctor? Heart failure can be life-threatening, so call 911 if you experience any of these signs or symptoms. Too many patients question symptoms or wait to seek emergency treatment, which can lead to further heart damage. Chest pain or tightness in your chest Fainting Severe shortness of breath that comes on suddenly Coughing up pink, foamy mucus Severe weakness If you experience other symptoms of heart failure, such as edema or lack of appetite, contact your doctor or cardiologist. With early diagnosis and treatment for congestive heart failure, it’s possible to live a long, healthy and active life. Talk to your physician about heart failure causes, symptoms, risk factors and treatments. Find more heart health resources at HealthChoicesFirst.com.
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
  • Dr. Graham Wong MPH, FRCPC
    Dr. Graham Wong MPH, FRCPC Cardiologist, Vancouver, BC 07 September 2018
    Atrial fibrillation is an irregular heartbeat, also called an arrhythmia, that can increase your risk of heart failure, stroke, blood clots and other heart conditions. A normal heart contracts and relaxes to a regular beat, but if you have atrial fibrillation, the atria (upper chambers) beat out of sync with the ventricles (lower chambers). The irregular heartbeat can cause blood to pool in your atria, causing blood clots that travel to your brain and cause a stroke. Possible causes of atrial fibrillation include: • Previous heart attacks • High blood pressure • Congenital heart defects • Coronary artery disease • Viral infections • An overactive thyroid gland Some people with atrial fibrillation have no symptoms. Atrial fibrillation symptoms can include: • Heart palpitations • Shortness of breath • Dizziness • Fatigue • Chest pain Atrial fibrillation isn't usually life threatening, but it is a serious medical condition that requires treatment. If you experience atrial fibrillation symptoms, consult with your doctor. Your physician may recommend an electrocardiogram to diagnose your heart condition. The goal of atrial fibrillation treatment is to restore your normal heart rate and rhythm and prevent blood clots. Your treatment may include medications, electrical cardioversion, a pacemaker or surgery.
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
    • Dr. Graham Wong MPH, FRCPC
      Dr. Graham Wong MPH, FRCPC Cardiologist, Vancouver, BC 29 June 2023
      A myocardial infarction, commonly known as a heart attack, is an acute event that occurs as a result of a chronic condition called atherosclerotic heart disease. During a heart attack, there is a blockage in the blood flow to the heart muscle, leading to the death of heart muscle tissue. The primary treatment for heart attacks involves the use of blood-thinning drugs, with aspirin being the most commonly prescribed. In certain cases, additional blood-thinning medications may be used alongside aspirin. One such medication is clopidogrel, also known as Plavix, and there are newer drugs available, such as prasugrel (Effient) and ticagrelor (Brilinta), that show promise in enhancing the efficacy of clopidogrel. It is important to note that all medications can have side effects, although their prevalence may vary. When it comes to blood-thinning drugs, including clopidogrel, aspirin, prasugrel, and ticagrelor, the most common side effect is bleeding. This can manifest as easy bruising or prolonged bleeding from minor cuts or injuries. Severe bleeding, such as gastrointestinal bleeding or bleeding in the head or eyes, is very rare and not typically associated with these medications. While bleeding can be bothersome and inconvenient, it is rarely life-threatening. However, it is important for individuals taking these medications to exercise caution to prevent accidents or injuries that could lead to bleeding. Another class of medications commonly used in heart attack treatment is ACE inhibitors. The most common side effect of ACE inhibitors is a dry, persistent cough. While this side effect can be irritating, it is not considered dangerous. If patients find the cough intolerable, alternatives can be explored. A rare but more concerning side effect of ACE inhibitors is angioedema, an allergic reaction characterized by pronounced swelling, particularly around the airways, which can cause difficulty in breathing. Although angioedema is uncommon, if breathing difficulties occur while taking an ACE inhibitor, it is crucial to seek immediate medical attention as it can be a medical emergency. While the aforementioned side effects are the more common ones associated with these medications, there may be idiosyncratic or rare reactions that are not as prevalent. If you suspect you are experiencing a side effect from a particular drug, it is recommended to consult your physician or pharmacist promptly. Since each individual's medical conditions and biology are unique, medication choices may vary for different individuals. If you have any concerns or issues related to medication, it is best to consult your own healthcare provider for personalized guidance.
  • K. Michael
    K. Michael 14 December 2015
    I've heard that the symptoms of a heart attack are different for women than for men. What symptoms do women need to be watch out for ?
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
    • K. Michael
      K. Michael 14 March 2016
      Recently there has been a hashtag trending - HEPPP. Stands for Hot, Exhausted, Pain, Pale, Puke. Those are supposed to be the most common signs for women suffering a heart attack
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 16 December 2015
      @K.Michael - heart attack symptoms in women can be more vague than the hallmark symptom of crushing chest pain that goes down into the arm. Women can experience pain in the arm, neck, jaw or even back. Women also may be more likely to have stomach pain if they are having a heart attack, as well as breaking out into a cold sweat. Fatigue is another complaint of women who are having a heart attack. As with any of these symptoms, it is best to call 911 and get assessed urgently to make sure your heart is ok.
  • K. Michael
    K. Michael 06 October 2015
    The case study indicates that Patrick is taking insulin. Does diabetes increase your risk of heart attack ?
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
    • AllieS
      AllieS 10 June 2016
      Yes, having diabetes significantly increases your risk of heart disease because of the damage high blood sugar does to blood vessels. For example, accumulated sugar can increase blood viscosity making it difficult to circulate, or blood vessels may become narrow as a result of fat deposits along the walls (again making blood difficult to circulate). Reduced blood flow to the heart is the key risk for heart attacks and other heart disease, so managing his diabetes and cholesterol is crucial for Patrick. Seeing a Registered Dietitian will be a very important part of his treatment plan in order to work towards this.
  • K. Michael
    K. Michael 27 July 2015
    In addition to the doctors suggested he might also want to speak to a counselor after his angioplasty procedure. Having a heart attack can create mental, as well as physical, issues
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
  • Joy
    Joy 04 May 2015
    What a shock to be awoken out of a sleep with chest pains and then within minutes be taken by an ambulance to have surgery. Good for him for asking such great questions before signing the consent form. I'm not sure I would be able to do that-I would still be in shock that I was having a heart attack and about to go into surgery!
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
  • Bernadette van der Boom-Bebb
    Bernadette van der Boom-Bebb 04 February 2015
    Seeing a nutritionist to get a healthy heart diet is a good idea. This video on Health Choices First has some more "Heart Disease Prevention Strategies". What did you think of the video?
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
    • K. Michael
      K. Michael 02 September 2015
      I liked the video and found it quite informative about the Healthy Heart diet
    • Joy
      Joy 04 May 2015
      Healthy Heart diet is a good one for anyone to follow, not just those who have had heart attacks or are at an increased risk for one.
  • ShirleyG
    ShirleyG 30 January 2015
    How to baby aspirins aid the person when having a heart attack ? Is this a common treatment for heart attacks ?
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
    • K. Michael
      K. Michael 12 February 2015
      I've heard the advice to chew two baby aspirin if you think you are having a heart attack but didn't think it was something that was readily available
  • ShirleyG
    ShirleyG 30 January 2015
    If you suspect a heart attack is it best to see a cardiologist to obtain an ECG to find out what is going on with your body or can a GP follow your symptoms/diagnosis ?
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
  • Yuan Lew, MSc MBA
    Yuan Lew, MSc MBA 15 January 2015
    My husband had a heart attack scare several years ago. It was explained to him that contrary to popular perception, a heart attack may not be sudden but rather a dull, sustained pain radiating along the left side.
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
    • Ms. Sarah Ware RD
      Ms. Sarah Ware RD Registered Dietitian, North Vancouver, BC 04 February 2015
      Very true. It's important to talk to your physician or other health professional to learn all the signs of a heart attack if this is something that you or a loved one are at risk of.
  • K. Michael
    K. Michael 08 January 2015
    What are the dangers / advantages of having the angioplasty now vs later ?
    Reply to: What is a Heart Attack? " Patrick a 70-year-old diabetic man with a 2-year history of stable chest pain"
    • Yuan Lew, MSc MBA
      Yuan Lew, MSc MBA 27 January 2015
      I am also interested, Michelle. Wouldn't the paramedics triage someone with a suspected heart attack and make sure that the individual gets the appropriate care once they arrive at the hospital?
    • K. Michael
      K. Michael 26 January 2015
      That's a very interesting observation Michelle. Would the ambulance not take you to the hospital best suited to your condition - provided you are stable and can safely wait the additional travel time ?
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 23 January 2015
      The angioplasty needs to be done in this case on an emergency basis, so if this patient does not have the procedure he will run the risk of more significant cardiac events. It is really helpful when you think you are having a heart attack or stroke to try and get to a hospital that has the ability for emergency procedures like this as it can prevent valuable time from being wasted (especially in the case of a stroke patient).

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