An above-50 patient came to me in the morning shift with chest pain for the last hour! He complained of two important associated features. His chest pain, even though not severe, was radiating to his left arm. He had a period of sweating during the first hour of pain! He was a wise person. Hence, without delay, he visited a doctor!
His past medical history was also significant. Previously he was diagnosed with hypertension, lipid disorders, and impaired glucose tolerance (pre-diabetes). He was also using nicotine! For the last couple of years, he didn't do any check-ups and he stopped all the medicines for the conditions mentioned above on his own!
I ordered an ECG. It showed the early changes indicating ischemic heart disease, not a complete MI/heart attack. I had two options in hand to reach a conclusion: waiting for another hour or two, repeating the ECG and seeing if more obvious changes come, or going for cardiac enzymes. The patients agreed to the blood test. We got the result within half an hour. It was an acute MI/heart attack case!
I spoke with the emergency department doctor over the phone, informed her about the patient, and, with her consent, escorted him to the regional hospital's emergency department.
The patient has all the risk factors (hypertension, lipid disorders, raised blood sugar, and nicotine use) for heart disease. He neglected, and fell into this trouble!
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Thanking you
Hafiz