To reach a diagnosis, we listen to the history of a patient first, then we do physical examinations, and finally do the relevant investigations. Investigations help us tremendously, no doubt. But the judgment, according to history and physical examination, is of utmost importance. If one investigation doesn't match the initial diagnosis, we need to do another investigation for the patient's betterment! Let's read a short story on this topic!
An above-50 came to me in the morning shift, at around 9 am. Since 6 am early morning, he started having chest pain. The history was somewhat atypical. His pain started in both arms and then shifted to the chest. He gave another significant history. He sweated profusely in the first hour of his pain. All his clothes were wet due to the sweat. He didn't give the history of nausea and vomiting. He was a heavy smoker. At the time of consultation, his pain had reduced a bit. Having the above-mentioned information in hand, my initial diagnosis was that it was a case of an acute heart attack. So, I advised an urgent ECG.
To my surprise, the ECG showed no features of a heart attack!! I was in a dilemma. I was almost going to discharge him with painkillers. But, the profuse sweating history was stuck in my head. Hence, I changed my decision and wanted to do cardiac enzyme marker (Trop T), which would remove all the confusion.
They agreed to do the cardiac marker blood test (it's a bit costly test). We got the result in half an hour! And, the result was positive for an acute MI (myocardial infarction aka heart attack). It was a case of an acute heart attack. He had some atypical presentation and his ECG didn't show the changes of the attack! It was a lifesaving-decision to go for the Trop T test, Alhamdulillah.
We gave the loading dose (recommended medicines for an acute event of MI). I talked with the regional hospital's emergency doctor and informed him the details. With his permission, we escorted the patient to the regional hospital emergency department.
Okay. That's all for today. Thanks for stopping by!
Hafiz