Question

The patient is a 35-year-old male who drove himself to the emergency department (ED) early in the morning because he had chest pain. The patient had been gambling in a casino overnight, drinking alcohol and snorting cocaine as well as smoking cigarettes. As the night progressed, the patient became aware of chest discomfort that advanced to chest pain. He had had chest pain on previous occasions, but this time it lasted longer and was more severe. He became scared and came to the ED. The patient does not have a family physician but does see a psychiatrist intermittently for his bipolar I disorder and is taking Lamictal 100 mg daily for this condition. The patient was admitted after the EKG was found to be abnormal and the patient's troponin lab values were found to be elevated. The admitting diagnosis was rule out myocardial infarction. Cardiology consultation was obtained. During his hospital stay the patient was monitored on cardiac telemetry, and the myocardial infarction was ruled out. A chest x-ray showed?

Answer 1

The patient exhibited classic signs of myocardial infarction, but after further assessment in the hospital, myocardial infarction was ruled out despite initial abnormal EKG and elevated troponin levels.

Step-by-step explanation:

The patient mentioned is experiencing symptoms that are indicative of myocardial infarction (MI), commonly known as a heart attack. However, after being admitted to the hospital with an abnormal EKG and elevated troponin levels, it was determined that he did not suffer an MI. Symptoms of an MI often include severe chest pain (angina pectoris), which may radiate down the left arm in males, difficulty breathing or shortness of breath (dyspnea), and other indicators such as irregular heartbeat (palpations), nausea and vomiting, sweating (diaphoresis), and syncope. The chest discomfort experienced by the patient, particularly after engaging in risk factors like smoking, alcohol consumption, and cocaine use, mimicked those of an MI, yet the patient was ultimately diagnosed with a different condition after myocardial infarction was ruled out.