A Lesson from the Cardiology Ward: Heart Attacks Without Chest Pain

Today was a real eye-opening scene for us in the cardiology ward. An elderly male patient (50 years) came in the ER with severe abdominal pain, nausea, and vomiting. Initially all of us including myself thought it to be a very severe case of gastroenteritis or perhaps a peptic ulcer. But thanks to our senior doctor, Dr. Khalid Naseeb (Consultant), we came to know the real issue that its a myocardial infarction (Heart Attack) presenting with gastrointestinal symptoms.

This experience taught me an important medical lesson that not all heart attacks must be present with chest pain or radiating to the left side. Sometimes they can mimic much common gastrointestinal issues like vomiting and nausea leading to potentially dangerous delays in proper diagnosis and the relevant treatment.

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The Importance of Considering Cardiac Causes

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As Dr. Khalid explained that now you should not call every case of abdominal pain and vomiting a heart attack but look for some certain symptoms and patient profiles should have to make us more suspicious immediately. Some risk factors include:

1. Elderly Patients: If an elderly patient suddenly develops severe, diffuse abdominal pain and vomiting, it’s a red flag.

2. Pre-existing Conditions (Comorbidities): Those with hypertension, diabetes, high lipid levels in their recent lipid profile or a history of smoking are at much higher risk.

3. Family History: A significant family history of cardiovascular disease can be a critical clue for a Myocardial infarction even at an earlier age.

4. Associated Symptoms: Additional signs like a gallop rhythm or an abnormal ECG findings or just elevated cardiac enzymes should prompt immediate consideration of a cardiac cause and must be referred for an immediate treatment.

The reason for all this is that the heart sits right above the diaphragm (a very important respiratory muscle located below the lungs and the heart, separating the thorax from abdominal cavity). An inferior myocardial infarction can irritate the diaphragm, triggering symptoms like vomiting and abdominal pain if diaphragm is pushing against the Gastrointestinal tract. That’s why it’s essential to consider a heart attack in these cases and quickly perform an ECG which will clearly indicate if it’s a Myocardial Infarction. There's no harm in doing an ECG it can swiftly confirm or rule out a myocardial infarction.

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Today's Case: A Real-Life Example

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So our patient today was a 50-year-old man from a rural area where advanced medical facilities and healthcare centres are limited. He came in with severe umbilical pain radiating to the epigastrium, cold sweats, and multiple episodes of vomiting and diarrhea. Given his history of hypertension and dyslipidemia, Dr. Khalid suspected a cardiac issue despite the gastrointestinal symptoms. He immediately called out for an ECG/EKG

_{Glasgow Coma Scale-measures a person's level of consciousness, read more about it and let me know your understanding on it in comment box}

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The ECG confirmed our suspicions, the leaf AVF, II and the III showing clearly that the patient had an ST-elevation inferior wall myocardial infarction (STEMI). Immediate treatment with aspirin and a referral for percutaneous coronary intervention (PCI) saved his life. In rural or resource-limited settings where immediate ECGs aren’t available, giving a patient with such symptoms aspirin (disprin) can be lifesaving. While aspirin might slightly worsen inflammation if the issue is purely gastrointestinal but it can prevent further damage and save a life if the problem is cardiac.

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This case was a stark reminder that when in doubt, never hesitate to suspect it as an MI and call for an ECG to rule out, especially with patients at risk for cardiovascular disease it's very crucial to think beyond the obvious.

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Key Takeaways for Non-Medical Readers

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1. Heart Attacks Aren’t Always Obvious: They can present as abdominal pain and vomiting, especially in older adults or those with certain risk factors.

2. Risk Factors to Watch For: Hypertension, diabetes, high cholesterol, smoking, and a family history of heart disease.

3. Quick Actions Can Save Lives: Promptly performing an ECG and, in rural settings, administering aspirin can be critical steps.

Remember, when it comes to heart health, it's better to be cautious and seek prompt medical attention even for seemingly common symptoms. Your heart might be trying to tell you something important

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regards,
Doctor @abdu.navi03