Under Pressure

Sixty-five year old Norman was accompanying his wife to her doctor’s appointment. That morning, he wasn’t quite feeling like himself. He was experiencing some mild nausea and fatigue that he’s had on and off for the past few months, but didn’t think much of it. He had a history of diabetes and hypertension, which he was told was very well controlled from his primary care doctor. Norman’s wife mentioned that they were feeling the pressure of making the appointment through rush hour traffic. While at the doctor’s office, he began feeling worse. His wife was about to get her blood drawn, when suddenly, Norman felt faint and passed out, collapsing on the floor. According to the medical assistant, she hadn’t even retrieved the blood draw supplies when it happened. Norman fell flat on his face, but came to almost immediately. He was helped up and assisted to a patient room. While there, I asked him how he was feeling. “I don’t feel good,” he said, as he sat in his chair. Suddenly, he had a pale look about him, became unresponsive, and stopped breathing. I scrambled to feel for a pulse. Nope. I stopped to listen for a heart beat. Quiet. The next thing I knew, I pulled Norman onto the floor and began CPR. Fortunately, after about a minute, he came back and started breathing independently and had a pulse present. When Norman’s wife calmed down and she had a second to process the events, she asked “What happened?”

For diabetic patients, the silent heart attack is more common than most people think. What happens is that diabetic patients develop neuropathic problems, like having numbness in the feet and hands. At times, the problem can advance and affect things like the heart, where pain is no longer perceived. Instead, a patient can sometimes feel nauseous or have mild discomfort, or feel a general fatigue. In some cases, patient’s will feel nothing at all, which is potentially dangerous, as they may never seek treatment.

Some symptoms of the silent heart attack can be very subtle. Patients, like Norman, can feel a general exhaustion. They can have a cold and clammy sweat about them. They can also have shortness of breath with minimal exertion or an upset stomach or feel lightheaded or dizzy. Having any of these symptoms in the context of diabetes warrants a workup.

Heart attacks happen usually as a result of a clogged or blocked heart vessel. When oxygen fails to be delivered to the heart muscle, it suffocates and begins to fail. Sometimes, these things happen as a result of bad choices like smoking or a rich, cholesterol laden diet. Sometimes these things are beyond our control as in the case of a strong family history. Diabetes is one of the biggest risk factors for this and routine maintenance and control are important for prevention. Blood pressure control is also an integral part of reducing risk.

Seeking treatment is extremely important in preventing the second, more deadly heart attack. At that point, patient’s can be placed on the proper medications, or perhaps, they can be taken for an elective procedure that can unclog the artery by way of placing a stent in it. It’s when patients don’t realize that they need to seek treatment where the problem lies.

When EMS arrived, Norman was conscious and able to answer questions. Thankfully, I was able to keep my wits about me and performed CPR as quickly as I did under pressure. It also helps that I just did the ACLS class less than a year ago. Norman kept repeating that he didn’t feel well. He was taken to a heart center for further testing. Pressure comes in many forms and chest pressure isn’t the only way a heart attack presents. Don’t let it get the best of you.

Post by: Dr. Juan Borja
Original Post Here

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