scubatoy Posted April 30, 2007 Share Posted April 30, 2007 Sunday morning at 11am husband calls 911 and says he thinks his wife is having a heart attack. Scenario: 31yo Caucasian female was sitting on couch watching tv when she noticed a squeezing pain just to left of her sternum in upper chest. Pain would come and go for about 15 minutes. Husband walked in and asked pt if she was okay. She put her hand to chest and said she didn't feel good. Moments later pt said her entire body went numb and she was having severe and constant pressure pain in the middle of her upper sternum. She tells husband she needs to go to the hospital because something is very wrong. Her entire body from head to toe goes numb. She stands up from couch walks 2 steps and then her knees lock and her whole body starts to shake. Husband says he grabbed pt and was able to move her back to the couch laying in fowlers position. Then pt started gasping for air and complaining she couldn't breath and felt like she was suffocating. Upon arrival to scene, husband is waiting outside for paramedics. He is rushes to them in saying his wife can't breath and thinks she is having a heart attack. 31yo female is found on the couch with head lifted up and knees bent. She is having shallow, labored breathing (approximately 6bpm) and she begs for O2 between breaths. Medics apply NR with high flow O2 and they start vitals and taking history. Pt is relatively healthy, 8yr old child. She had a kidney infection 4 months prior to and a hysterectomy 2.5yrs ago due to endometriosis. She denies any strenuous activity or sleeping wrong. However, pt was at a party the night before and had been drinking heavily. Pt does not smoke or use recreational drugs. Current medications include paxil and welbutrin for anxiety/depression and pt had recently been taking adipex for just over a month for weight loss. After approximately 5 minutes of high flow O2 pt starts responding more and answering more questions. She says her pain is now a 5 from a 7. Medic palpates chest and pt screams when touches sternum just to side of left breast indicating chest wall pain. Vitals: 5'8 165lbs bp 147/93 hr: 105 resp 8bpm shallow and labored skin is dry and warm lung sounds clear and bilateral temp 100.3 good pms 12-lead showed no sign on MI Package pt and load. Start line and medic contacts medical control on whether to give nitro. MD says to only give baby asa for now. Medics comply and eta to ER is 12-15 minutes. At ER pt continues to improve and now only complains of chest tenderness. Respiratory returns to 14bpm and heart rate drops to 91. Temp hovers just over 99 for the first few hours and then stabilizes. BP drops to 137/p and 2nd ekg again confirms no sign of cardiac emergency. All blood work comes back normal. All vitals return to normal by end of night and only cc pt still has is chest tenderness and severe chest pain when eating. What do you think happened? Link to comment Share on other sites More sharing options...
ERDoc Posted April 30, 2007 Share Posted April 30, 2007 That depends on what you mean by "All blood work comes back normal." What things was she worked up for? Things that come to mind include MI, PE, anxiety among others. This does not sound like a seizure, more of a vasovagal reaction. You can get shaking with vasovagal syncope that can resemble a seizure. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted April 30, 2007 Share Posted April 30, 2007 I was thinking the same thing Doc.. as well as possible esophageal spasms, with increased anxiety. Need more pertinent history, and details. R/r 911 Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 30, 2007 Share Posted April 30, 2007 What else was she doing while on the couch. Now before you all get your knickers in a bunch and think deviantly, was she eating prior to this episode? Did she take a larger drink than normal. Did she feel something catch in her throat when she swallowed? I suspect a couple of things 1. separation of a rib or two from the sternum 2. Esophageal tear 3. Vaso vagal 4. regurg or GERD Or her husband got pissed at her and popped her in the chest. Link to comment Share on other sites More sharing options...
spenac Posted April 30, 2007 Share Posted April 30, 2007 Was she doing the bills? Did her husband say no to buying something she wanted? Did she get bad news? Sounds like if eveything else checked out a simple case of HFS. OOPs I forgot to call medical control to see if I could think I better leave and come back later. Link to comment Share on other sites More sharing options...
scubatoy Posted May 1, 2007 Author Share Posted May 1, 2007 Sorry didn't get a chance to get back online. Pt had had oatmeal, buttered toast and black coffee 2hrs prior to incident. Don't think husband popped her, but hey maybe he forgot to mention it! Pt was not drinking or eating at time of episode, supposedly only watching tv. Not arguing with husband or talking to anyone, just watching tv. Not reading or doing bills (but that definitely could have caused it in my case!). No other history available. Bloodwork checked for cholesterol, thyroid, diabetes and a series of test for changes in enzyme levels. No enzymes found, no diabetes or thyroid problems and cholesterol was excellent. Link to comment Share on other sites More sharing options...
katbemeEMT-B Posted May 1, 2007 Share Posted May 1, 2007 I have had a similar experience, not as an EMT but personally. All the same symptoms except for the locking of the knees. I sought medical attention because I too thought it was my heart. After endless tests and EKGs the doctor could find nothing. I finally went to a different doctor who diagnosed it as part of my acid reflux intensified by anxiety. He ran a test for H-Pylori which was positive and scheduled me for an endoscopy. This confirmed his initial diagnosis. My stomach was inflamed due to the acid reflux and was pushing up into my esophagus. This was causing the pain and tenderness in the sternum along with extreme pressure in the chest. The pressure in my chest would increase due to anxiety as I was scared I was having an MI. It was actually the anxiety that caused the numbness throughout my body. The doctor treated the H-Pylori and acid reflux and I have had no problems since. Link to comment Share on other sites More sharing options...
scubatoy Posted May 1, 2007 Author Share Posted May 1, 2007 I have had a similar experience, not as an EMT but personally. All the same symptoms except for the locking of the knees. I sought medical attention because I too thought it was my heart. After endless tests and EKGs the doctor could find nothing. I finally went to a different doctor who diagnosed it as part of my acid reflux intensified by anxiety. He ran a test for H-Pylori which was positive and scheduled me for an endoscopy. This confirmed his initial diagnosis. My stomach was inflamed due to the acid reflux and was pushing up into my esophagus. This was causing the pain and tenderness in the sternum along with extreme pressure in the chest. The pressure in my chest would increase due to anxiety as I was scared I was having an MI. It was actually the anxiety that caused the numbness throughout my body. The doctor treated the H-Pylori and acid reflux and I have had no problems since. That's exactly what it was. Echo showed the heart itself was in good condition, with minor leaky valves - not enough to cause concern. Pt was discharged with OTC pills! Link to comment Share on other sites More sharing options...
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