Did She Just Overdo It?

by Jennifer Carlquist, PA-C

Ms. Z is a 40 year old female who was attempting her first half marathon. She reported at mile 11 didn’t feel well. It was hot that day and she thought she was dehydrated. She stopped to call her husband who met her mile ten where she said she had to lay down and, after 20 minutes, she called 911.

She was hydrated with 500 ML fluid bolus, Zofran 4 mg IVP, and she felt better. She had a 40 minute ride in the ambulance to the nearest hospital, and because she felt better, signed out AMA before they arrived to the ER.

She went home, and tried to eat, but had too much chest pain, so she tried to nap. She slept for half an hour, but woke up and had discomfort/chest pain that radiated into right arm. She tried to lay in certain positions for comfort, took a shower, then got diarrhea. At that point she started vomiting, husband called EMS and on arrival, met them at the door with her wallet “ready to go this time”. As they hooked her up, here is what they found…

On cardiac catheterization she had a 99% occluded RCA that was stented. She has done well since. Her risk factors were obesity, hyperlipidemia, HTN, NIDDM untreated. It is often said that cardiac patients experience denial, so much so that they delay seeking care, as she did. Luckilyl it did not compromise her ejection fraction, but she was lucky. She was also quite young to have a myocardial infarction, and being female, this also made it more unlikely. This is a case where her comorbidities made her “heart age” higher than her chronological age.

You can see Jennifer Carlquist, PA-C speak at the GAPA 2019 Summer Conference in Hilton Head Island, SC.

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