Image IQ: A 66-year-old woman with fatigue and jaw pain

December 5, 2019

A 66-year-old woman was experiencing severe fatigue and jaw pain for more than an hour. When she started feeling short of breath, she was worried enough to head to the ED. She vomited while waiting to be seen and broke out into a cold sweat. Until this event, she had been enjoying her first year of retirement and was rarely at the doctor. What's your diagnosis?

A 66-year-old woman was experiencing severe fatigue and jaw pain for more than an hour. When she started feeling short of breath, she was worried enough to head to the ED. She vomited while waiting to be seen and broke out into a cold sweat. Until this event, she had been enjoying her first year of retirement and was rarely at the doctor.

Can you diagnose this patient?

A. Generalized anxiety disorder
B. Unstable angina
C. Influenza
D. Myocardial infarction

Use the differential builder on VisualDx to guide in your decision: http://bit.ly/2FBuDHV

See the next page for the answer.

The correct answer is (d) myocardial infarction.

Synopsis

Clinical or pathologic event caused by myocardial ischemia, most often secondary to plaque rupture with subsequent thrombus formation, with resultant myocardial injury or necrosis as demonstrated by the rise and fall of cardiac biomarkers (troponin, creatine kinase-MB [CK-MB]) in the setting of typical symptoms such as chest pain and shortness of breath. Furthermore, there must be evidence of underlying myocardial damage such as suggestive ECG (echocardiographic) evidence of loss of viable myocardium or new regional wall motion abnormality. Acute myocardial infarction can be classified as follows:

  • ST-elevation myocardial infarction (STEMI) – Demonstration of new ST segment elevations, new left bundle branch block (LBBB), or new posterior infarction with ST segment changes on ECG in a patient with chest pain and elevated cardiac biomarkers.

  • Non ST-elevation myocardial infarction (NSTEMI) – Demonstration of ST depressions, T-wave inversions without ST segment elevations, or pathologic Q waves on ECG in a patient with chest pain and elevated cardiac biomarkers.

  • Unstable angina – Patients with chest pain and ischemic symptoms without elevation in cardiac biomarkers and with or without evidence of ischemia on ECG.

A 2018 study has shown that patients with acute myocardial infarction and cardiogenic shock have a lower risk of death at 30 days following culprit-lesion-only percutaneous coronary intervention (PCI) than with multivessel PCI. However, mortality at 1 year following treatment was not significantly different.

For more information about this diagnosis, including ICD 10 codes, visit VisualDx.