A Patient With a Silent Heart Attack! | Random Chamber Talk | Dec 01, 2024 |

25 days ago

Today an above 60 local patient came to me. He was a patient with hypertension (high blood pressure) and diabetes! For the last two days, he had chest discomfort and breathlessness on mild exertion (walking or climbing stairs). He also had a cough. He didn't have typical several chest pain like a heart attack patient.

On examination, I found his BP quite high. His temperature was normal. Chest examination revealed abnormal sounds at the base of the lungs (could be due to pneumonia or heart failure). His blood sugar was within normal limits.

I planned for an ECG, chest X-ray, and CBC. The ECG findings were abnormal but weren't clear-cut for an acute heart attack (MI). I ordered cardiac enzyme (Trop T) and the result was above the normal limit. That means it was a case of an acute MI (heart attack). In medical language, it is called NSTEMI! The lung findings suggested the heart attack with complicated with heart failure!

A diabetic patient may not feel the severity of the pain of an acute heart attack. Hence, the diagnosis is often missed. Uncontrolled DM may conceal the typical presentation of a heart attack leading to a silent MI, which is quite challenging for the doctors. I was lucky today, Alhamdulillah.

Anyway, as a protocol, I talked with an emergency physician at the regional government hospital. After giving some emergency medicines, we escorted the patient to the emergency department.

Let us enjoy two photographs before ending the post. An evening and an afternoon photographs!

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