Expect The Unexpected

I’ve just come on shift and I’ve got a good supply of energy this morning, I’m scouring the emergency room for tasks to accomplish. On our electronic display board, I see that an EKG has been ordered. I grab the machine and head to the room designated on the board. I peek in the room and see no one in the room, as I turn around, the patient comes walking past me into the room.

There must be some mistake, the patient looks younger than me (and in fact was) and they look to be pretty healthy and “normal.” I double check the board to be certain that I’m seeing things correctly…sure enough- the EKG was ordered for this patient. It’s a bit odd, but in the ER, docs have to make sure they cover all the bases. Ordering a test that checks the electrical activity of the heart on a young person isn’t usual but since it’s easy and quick, sometimes it’s just better to do it..

I tell the patient what I’m going to be doing and they seem to think it’s a bit silly too…but I explain to them that it’s pretty routine for anyone complaining of any chest pain. I get them connected to the machine and before the machine is calibrated and ready to print…I can see some serious S-T elevation coming across the screen.

I’m no doctor, nor am I an expert in EKG interpretation, but when elevation of the S-T portion of the heart rhythm is present, it usually means “acute MI.” Acute myocardial infarction is a fancy way of saying that portions of the heart tissue are not receiving blood and are dying- a heart attack. I leave the EKG connected and take my findings to the ordering doctor. The doc comes back into the room and moves a few leads around and we shoot another picture. Again- “Acute MI,” is the reading.

Up to this point, the patient has no idea, as I left the room calmly and the doc is one of our most relaxed, calm, and confident providers. “Well, it appears-from this reading, that you may be having a heart attack. This test is very sensitive though, once we get the blood work back, we’ll know for sure.” The kid is in shock…”A heart attack?”

The doc plays it safe and calls the Cath Lab team over and readies this “kid” to go have a Cardiac Catheterization. It’s not usual for someone in their early twenties to have a blocked artery- it’s more common for drugs to be the cause- specifically cocaine.

I ask the patient if they had done any cocaine, they reply that when they were younger they had, but not in the past few days. The patients blood work comes back and their level of triponin (a chemical that is released when heart tissue dies,) is 10 times what qualifies as High! They are definitely, definitely having a heart attack.

Just before they leave to go to the cath lab, they let the doc know- ” I did snort something two days ago, it could have been cocaine but I don’t really know what it was…”

The angio comes back clean…no blockage. A phenomenon known as prinzmetal angina can occur naturally but is also associated with cocaine use. Major vessels of the heart spasm so violently, that they clamp shut- simulating a complete blockage.

I still don’t know whether they really didn’t know what they were snorting or if they were too ashamed to admit- that they had given themselves a heart attack by snorting cocaine. What’s the moral of the story? If you don’t know what it is…you probably shouldn’t snort it. But we all wanna have fun right?

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