When Is a Heart Attack Not a Heart Attack?

NY Times ^ | March 16, 2008 | LISA SANDERS, M.D.

[neverdem]

Diagnosis

1. Symptoms

“I don’t think he had a heart attack,” the patient’s wife declared emphatically. “I don’t care what the doctor in the hospital said.” The patient nodded his agreement. “But we need to be sure,” she added in a distinctive Long Island accent. That’s why they had gone to see Dr. Bruce Decter in New Hyde Park, N.Y., a cardiologist just out of training — to get a second opinion from someone a little closer to the books. The patient, a lanky 42-year-old man with a chiseled jaw, retreating hairline and skinny ponytail, seemed tired and anxious and grateful to have his childhood sweetheart do all the talking.

He had chest pain off and on for most of his adult life. His internist didn’t think it was his heart, and a normal stress test done the previous year seemed to confirm that. Then the week before his visit to Decter, his chest began to hurt while making love. It spread to his left shoulder and arm. And it didn’t go away. He hardly slept at all that night because of the pain and a gnawing anxiety that this time it really was a heart attack.

First thing the next morning he went to his internist...

--snip--

The blood test in question measures an enzyme that is released when a muscle like the heart is injured. That enzyme, creatine phosphokinase, abbreviated as CPK, was normal when the patient first presented to the emergency room but rose to a level 20 times higher than normal over the next several hours. In a patient who has chest pain that comes on with exertion, an elevated CPK usually means that the patient is having a heart attack...

[neverdem]

Left: Photo Researchers. Right: Steve Gschmeissner/Photo Researchers
The patient’s symptoms and blood tests indicated heart attack (left) but could also have pointed to damaged skeletal muscle tissue (right).

Jan Schwochow
Something was fishy when they didn't find an elevated CPK-MB fraction.

The clinical need for high-sensitivity cardiac troponin assays for acute coronary syndromes and the role for serial testing.

Diseases of Muscle and the Neuromuscular Junction: Metabolic Myopathies

I was groping for one of the porphyrias when I read dark urine.

[grey_whiskers]

bedtime! bfl.

Cheers!

[boop]

What an odd presentation of disease. The cardiologist had to think cardiac until proven otherwise.I remember from med school a porphyria can give a pseudo-appendicitis as well.

[Fiddlstix]

Bump

[wardaddy]

as someone who’s had two open heart surgeries due to a malformed from birth LAD I can tell ya:

if you think it’s a problem with the heart, then get to an emergency room even if you have to drive yourself at 2AM in the snow like I did with my wife on my cell phone with me till I got there

it can save you.....if you’re wrong you feel great...a bit silly but still smelling the roses

if you see dark gloomy peripheral stuff and a little voice that sounds like God telling you to get a move then do.....I stood in kitchen and took my BP and it was high ..150/100....never been high before and I remember my inner voice telling me to get help...i had no chest pain or pressure just a dull pain in my armpit where I had already had two motorcycle surgeries but nevertheless I listened

I was a bit yellow too ...sorta mottled looking

* they did threads on me here...i won’t bore anymore

[Brandybux]

if you see dark gloomy peripheral stuff and a little voice that sounds like God telling you to get a move then do

Most hearty agreement from this quarter. LOL

I was looking for a heart attack, since most of my maternal uncles were already dead from ages 38 to 50 from coronaries. When mine came, at the end of an aerobics class I had attended for a couple of years (!), I knew it was for real within 30 seconds. Blue lips really don't look very healthy, dontcha know.

Five minutes later I was on the way to the hospital. Five minutes later I arrived in ER, and 15 minutes later they were shooting me up with one of those clot-buster drugs. Twenty minutes after that, the pain melted away over a period of about 15 seconds (I was watching the clock while waiting in ICU to see what was gonna happen).

Angioplasty followed. Ninety days later, one of those whiz-bang heart scans showed no heart damage at all. My doc had earlier told me that the CPK level had barely bumped up.

The point: get to the ER fast. My internist had another chap my age, a week later, get the same heart attack I had. But, he waited 12 hours to seek help. By that time, he'd lost significant coronary function, and today he's still alive but on permanent disability.

[pallis]

I have a valve that makes an EKG read like I’m dying of congestive heart failure.

[Monitor]

When mine came, at the end of an aerobics class I had attended for a couple of years (!), I knew it was for real within 30 seconds.

I hear that. I'd been biking 20 miles per day for three years when I started getting a heart burn during my rides which didn't respond to antacids. Lucky for me it was angina; I had four blockages: 20%, 30%, 80%, and 90%. I was one small clot away from a heart attack. Two stents later and I was as good as new.

They still made me go through 12 weeks of cardiac rehab, which allowed me to see what the survivors of heart attacks looked like, and it was pretty harsh.

[Shery]

I just had one of these attacks the Monday before Thanksgiving! Trying to determine if Gall bladder, but the chemistry wasn’t there, even though the pain was. It was the porphyria, instead.