When heartburn is not heartburn, and be careful whom you challenge

Sure enough, there might have been something to say for the prediction of an increased incidence of heart attacks around a major sporting event.

A 50-something gentleman came into clinic yesterday with “burning around my heart”. [side note: I’m always intrigued by the choice of words used in an individuals “chief complaint” – there’s something about that phrase that just has to make you feel uneasy. Reminds me of an amazing patient I had in residency – that’s for another day.] The guy has a history of heart problems – which I later realized when I finally got my hands on the archaic stone tablet, er . . . paper chart. His pain was actually quite unusual to be blamed on the heart, in the sense that he has huge physical demands on his job that never exacerbated the pain. Interestingly, the pain had been stuttering along for a few days and he just wasn’t his normal self for the Super Bowl party he attended. I requested an EKG on him right away because it just didn’t sound right.

EKG looked like an early MI (heart attack), with a finding that is a bit subtle, but nonetheless inexcusable to miss. An ambulance was summoned, and the daft baboons on the ambulance squad had the nerve to argue with me about whether or not the EKG was concerning for heart disease. [insert deep inner rage] Here I spend 40 minutes with the guy and have a ridiculous number of years of training, and some poser medic with no real patient care experience tries to tell me I’m wrong. If I wanted help reading an EKG, the paramedics would be among the last people I would ever ask – pick him up and get out of here. Now, ask me if I would feel comfortable with these baboons caring for my family in an emergency. . . yikes!

Lo and behold, he had an MI, went to the cath lab immediately, and had a near-total occlusion of the dominant heart vessel that got the “roto-rooter” treatment and was stented. I’ll be having a [not-so-kind] word with the ambulance company later today.


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