your insight please

[MDjohnny]

67 year old female. Retired asian cuisine cook. No previous history of heart disease or MI. After coming back from a european trip, she complained of cough productive of white sputum without fever or chills, intermittent abdominal epigastric pain that felt like "stomachache" that occured intermittently. She took pepto-bismol and developed intemittent nausea and vomitting after several times afterward without evidence of gastrointestinal blood loss. She declined to come to the emergency room, although her husband had suggested this and finally agreed.
There is no history of tobacco and alcohol use but she does have high blood pressure, diabetes, and elevated cholesterol.
An x-ray showed diffuse bilateral infiltrates with increased vascualr markings, prominent hilar markings with borderline cardiomegaly. An electrocardiogram showed normal sinus rhythm with first degree block and evidence of diffuse ST-T wave changes in the inferior lateral leads predominantly. Small Q-waves were noted in the inferior leads.

My insight- patient declined an emergency room because she thought it was only a "heartburn" and nothing serious. So lack of knowledge that MI has different symptoms besides chest pains and hard of breathing.
What's your insight?

Thanks.

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[zenman]

Insight on her decision...or condition?

 

[Bandit]

FISRT disclamer!!! need more info and vitals.

second, so far you have CP/SOB/cough/ with apperent "infiltrates" and or vasc pulm congestion. These ST changes ytou speak of---WHAT KIND of changes?? Elevation, flattening, depressed, in verted?? These are all RCA with or without recip changes?? "slight CM" with these sx are suggesting possible right sided heart problem without eveidence of left sided (yet)

if the #1 cause of right sided is indeed left sided--and we elinminated left sided--then what?

PE, Pulm htn, ami (or evolving), pulm insult (poss infectious) hmmm, asian cook huh? I love this acedemic stuff!! Hints like this are usually intended for something. how off base is it to think about crazy stuff like TPE or other parasitic lung infections? might also explain the nausea, vomit (unless that is simply vegas irritation)

give us more

 

[lloydchristmas]

I recently attended a conference and the speaker referenced a recent study on AMI in women and the number one presenting symptom wasn't CP, SOB, Diaphoresis, jaw or arm pain. It was fatigue. So this proves my theory that women are incredibly difficult to interpret.

 

[deleted6669]

"So this proves my theory that women are incredibly difficult to interpret."

don't need a study to tell me that one, I'm married....