Silent MI or Why Intuition Is A Good Thing

We get called to a lot of “Rubbish” jobs, and always there is the temptation to leave them at home after giving them a bit of health promotion advice (A.K.A “Telling them off”). Sometimes however you have to listen to your intuition and take them – even if the patient doesn't want to go…
(You have to “persuade” them, we can't kidnap people off the street – not yet anyway)

We got called to a 53 year old male who was complaining of difficulty in breathing. When we got there the man was sitting on the floor hyperventilating, after a bit of a chat he told us that he has a history of hyperventilating and of gastric (stomach) pain. He looked alright to me, but there was something that I didn't like about him. He didn't have any other symptoms and his breathing soon settled down to normal leaving him with the gastric pain – which he could control with his medication.

But something just wasn't right – so I persuaded him to come down to the ambulance for a check-up. We wheeled him downstairs and connected him up to our ECG machine – which shows the electrical activity of the heart.

We saw this…

Which I suspect will have the medics who read this weblog jumping up in their chairs.

Basically he was having a heart attack.

Needless to say, we rushed him to hospital, where he got the treatment he needed and has made a good recovery. He had none of the other signs and symptoms of having a heart attack – he wasn't sweaty, his breathing was due to his hyperventilating, he wasn't having any cardiac pain and he just didn't look like he was having a heart attack.

Don't ask me why I thought he needed an ECG, don't ask me why we wheeled him downstairs instead of making him walk, I just guess it was intuition – and I've learnt to always listen to my intuition.

For those who don't know what the above picture shows, allow me to educate you.

The pattern that is normal for a heart trace is more or less this…

But in a heart attack something called the “ST Segment” is raised above the normal line like this…

Basically if it is raised more than two of those little squares there is a strong suspicion that a heart attack is causing it

For all those who are medically trained, I know that this is overwhelmingly simplistic, but I thought I'd give it a go…

For more information you might want to check this site or even here

3 thoughts on “Silent MI or Why Intuition Is A Good Thing”

  1. Excellent post. I haven't had much time to study ECGs yet, but over the summer I definitely will be. Thanks!

  2. A nice Anterio-Septal MI.You can also get a confirmation by the ST depression in the reciprocal leads II, III, AvF.

    Once had a pt whose only complain was right elbow pain. The Doctor said that is one of the Atypical signs. Strange how phsyiology differs from pt to pt.

    FYI, Thats what we would call Tombstoning here. Esp in V2 and V3.

  3. One of the docs I work with said that if it wasn't for ECG machines he would have lost a patient. Epigastric pain, no significant cardiac history, but something not quite right. Either give him som Gastrogel and sit him back in the waiting room, or an ECG to check and then Gastrogel? ECG, MI, bloody silent and deadly does not refer just to flatulence…

Leave a Reply

Your email address will not be published. Required fields are marked *