Dear Fiction Dr.,

I have a character who goes to the hospital thinking he's having a heart attack. It's only stress. How long would it take for the docs to rule out an MI? What tests would they have to run? What signs would indicate stress / panic attack vs. real cardiac event?

Thanks,
Doug

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Dear Doug,

A patient presenting to the emergency room with palpitations, chest pain, and sweating (even following an emotional altercation) could be having either a panic attack or an MI. Most ER's have an emergency protocol that requires the triage nurse to obtain an ECG within five minutes of the patient's arrival, before the patient is even seen by a physician.

The ER doctor then immediately reads the emergency ECG. If the ECG is abnormal, (flipped T waves, ST elevation or depression, etc) the patient would be rushed through for treatment with O2, Nitrates, morphine, aspirin or anticoagulants, etc.

If the ECG is non-diagnostic, cardiac enzymes (eg. troponin, ) would be drawn at 0 hours, 4 hours, and 8-12 hours post onset of symptoms. The blood work takes less than an hour each time to come back from the lab. Alternatively, some ER's have bedside kits that give you a result within minutes.

Risk factors in the patient's history that would make the doctor lean more toward an MI than a panic attack: prior coronary artery disease, hypertension, diabetes, smoker, high cholesterol, older age, use of street drugs (cocaine, amphetamines).

History that would suggest panic attack: younger person with none of the above risk factors, prior or repeated attacks peaking within ten minutes with no other apparent physical causes.

Hope that helps!

Best Regards,

Dr. Karen

 

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