Heart Attack - Hospitalization, First Day

After experiencing incapacitating pressure in his chest, a to 911 with an ambulance ride to the hospital, Jim was admitted to the nearby hospital in Massachusetts. At the hospital he was seen by a cardiologist who noted that although his EKG was normal, his Troponin blood enzyme levels had risen slightly in the first few hours since the heart episode that morning. Although Jim and I had never heard of Troponin before, we were about to find out all kinds of things about this highly, highly significant (to cardiology) enzyme. From Wikipedia:

Certain subtypes of troponin (cardiac troponin I and T) are very sensitive and specific indicators of damage to the heart muscle (myocardium). They are measured in the blood to differentiate between unstable angina and myocardial infarction (heart attack) in patients with chest pain. A patient who had suffered from a myocardial infarction would have an area of damaged heart muscle and so would have elevated cardiac troponin levels in the blood.

Jim's troponin levels continued to rise during the 6 hours after the heart episode. This was crucial to the correct treatment and management of the medical treatment given to Jim. Remember, that his EKG was normal. Most likely, 20 years ago Jim would have been released from the hospital without the treatment he desperately needed-because only in the last few years has troponin been measured during the hours after a likely heart attack.

Reason for Admission/Chief Complaint from the Discharge Summary:

56 year old man with no significant PMH (past medical history) who was transferred to BMC (Boston Medical Center) from Caritas Christi Norwood Hospital for cardiac catheterization. Patient reports being in usual state of health until the morning of admission (01/08/08) when shortly after eating breakfast he developed a feeling of "fullness" in his esophagus. He has had this in the past and has attributed it to heartburn and mild swallowing difficulties. The difference this time was that the sx's recurred. Over the ensuing 1 1/2 hours he experienced 4-5 episodes of discomfort associated with nausea, diaphoresis (excessive sweating commonly associated with shock and other medical emergency conditions) and generalized upper body weakness in a crescendo pattern. He was noted by his co-workers to be acutely pale and diaphoretic and 911 was called. Episodes lasted approximately 15 minutes. He felt better lying down, was given Ntg (nitroglycerin) spray x2 and ASA by EMT's with minimal relief and transported to Caritas Christi Norwood Hospital. He became pain free, EKG demonstrated ST elevation in lead III and the R/I for NSTEMI (Non-ST-Elevation Myocardial Infarction) with CK (also known as CPK) 297 MB 22.6 and troponin 3.4.

At the hospital Jim was put on an IV and given a blood thinner (heparin), aspirin, and blood pressure lowing medications.  Jim was not permitted to  even stand upright after he was admitted to the hospital.

Here is the EKG results for Jim on 1/8/2008:

Normal sinus rhythm with sinus arrhythmia (Wikipedia: Sinus arrhythmia is the mild acceleration followed by slowing of the normal rhythm that occurs with breathing)
Normal ECG
No previous ECGs available
786.50 ICD-9 Code for normals and any codes not available in MUSE (I think that this is a standard to compare medical test results with)

vadkins