1051 Case Study - Carmen Meyette

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Jan 9, 2024

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Case Study: A Distinctly Feminine Heart Attack Carmen Meyette Biology Department, Trent University BIOL 1051: Human Physiology Dr. Liliane Dableh March 30 2023

1 Introduction and Case Report Vivian is a 46-year-old lawyer who noted that she has been increasingly fatigued over the last four months, and despite feeling tired she is not sleeping well. This week she has experienced a burning sensation in her chest. As she has been working long hours and choosing fast, convenient food options she attributes her chest pain to heart-burn resulting from low- quality food. She becomes nauseous, starts vomiting and does not improve while resting at home. Two hours after the nausea begins her husband suggests she should go to the local emergency department. At the hospital she is given an electrocardiogram (ECG) and an irregular rhythm is noted, a blood draw is taken for testing and cardiac magnetic resonance imaging (Cardiac MRI) is performed. Her tests return the following results: Heart rate: 65 BPM ECG: ST-segment depression (6.5 mm), t-wave inversion (2 mm) Blood Pressure: 145/95 Temp: 38.5 o Cardiac MRI: Reduced cardiac function Blood troponin levels: 0.44 ng/mL The choice to perform these tests in response to the symptoms described above highlights the health care team’s knowledge of how beneficial early detection and intervention is for myocardial infarction (heart attack) and other cardiac events. The focus now that these results have returned should be to restore optimal cardiac function and identify, if possible, the cause of Vivian’s cardiac event. Discussion Heart attacks are often related to plaque building up in the arteries and dislodging, causing an obstruction. They may also be related to a coronary artery spasm, spontaneous coronary artery dissection, or a supply and demand mismatch (Khan et al., 2022).

2 Research suggests that heart attack symptoms differ between men and women. In a study that examined the cases of women who experienced heart attacks the women reported feeling fatigued for up to six months, and a reduced quality of sleep in the last month precipitating a heart attack. In fact, many of these women reported that they never experienced the aching, tightness and pressure in their chest that is traditionally associated with a heart attack (Nakazawa, 2004). These variations away from the traditionally known symptoms of a heart can also fool health care professionals. In one case a woman reported to her primary provider complaining of low sleep quality and increased burning sensation in her chest over the course of a few days. The nurse practitioner assessed that these symptoms, in combination with the patient’s obese status and low-quality diet (fast food) suggested she was experiencing acid reflux. They recommended an appropriate medication for this and sent her home. When she followed up to report the symptoms had not subsided there was no appointment available, and she was advised to continue the acid reflux medication. She later died of a heart attack (Latner, 2016). In Vivian’s case her health care team at the emergency department decided to perform the appropriate tests that would detect or rule out a heart attack. An ECG quickly and succinctly identifies the real-time function of the heart and can reveal important alterations to the rhythm. In this case the ST-segment depression and t-wave inversion indicate that there is a problem. (Ojha & Dhamoon, 2023). Blood troponin levels would normally be so low they would be border-line undetectable. Troponin in the blood indicates damage to the heart. However the levels at which blood troponin indicates specifically a heart attack, and not another concern, fluctuates depending on the test. Levels that indicate a heart attack range from 0.12 ng/mL to 0.34 ng/mL (Juliano & Watson, 2017). Lastly the cardiac MRI would allow the medical team to visualize

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