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Post by anneinwa on Jun 6, 2017 18:52:35 GMT
Answers here really won't do anything but either settle questions I have or cause more.
During a recent hospital stay we found out my MIL had a major heart attack sometime in the past week to month. Due to her dementia they said it's not surprising no one noticed.
She was in the ER twice within a week (Monday and Thursday) and was admitted the second time. Both visits were unrelated to heart problems but she was admitted due to possible CHF based on something they saw on the X-ray. An echo showed the heart attack evidence.
Would blood work from either ER visit show whether a heart attack was coming or whether it had happened? How many days (or is it just hours) would the evidence be in the blood?
Am curious whether it could have happened between those two visits because something was really off when we met her at the hospital Thursday. As my husband said after seeing her 'something is really different this time.'
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Post by Zee on Jun 6, 2017 19:01:41 GMT
Bloodwork would not show a heart attack is coming. The markers used are proteins released by damaged muscle tissue. An EKG would show ischemia (narrowed blood flow) or infarction (blocked blood flow with heart muscle damage). Serial troponins are blood tests that would show a myocardial infarction as/after it's happening, coupled with EKG changes.
You'd have to know troponin levels for both visits, as well as what the EKGs showed, interpreted by someone knowledgeable--not just what the machine predicts and prints.
ETA troponin is not the only marker used, but it is the most specific to myocardial (heart muscle) tissue. It will start to rise about 2 hours after a heart attack and is usually measured on admit for chest pain, again in 2 hours, sometimes in 2 more hours, and usually every 8 hours x 3. If she came in for something totally unrelated it's unlikely that any cardiac markers were drawn. Troponins usually peak in 24 hrs but can stay elevated for a week or two. You have to have more than one drawn to see the rise and fall pattern to know about when the onset was, if the heart attack was silent.
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Post by lisacharlotte on Jun 6, 2017 20:43:24 GMT
My mom had a silent heart attack in her 50's. They found evidence of it when she was going to have bypass surgery. She had no clue which is more common in women since our symptoms are typically different that the classic male heart attack.
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Post by anneinwa on Jun 6, 2017 21:27:50 GMT
Ok thanks. Figured it was a long shot.
In the end it doesn't really matter but I am curious when it happened.
CT was done the first visit (they wanted X-ray but I asked for CT to look at something else at same time so I didn't have to take her out the next week for an ultrasound.
They did a ekg the second visit but not the first time.
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Deleted
Posts: 0
May 8, 2024 7:44:02 GMT
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Post by Deleted on Jun 6, 2017 21:27:59 GMT
My mom had a silent heart attack in her 50's. They found evidence of it when she was going to have bypass surgery. She had no clue which is more common in women since our symptoms are typically different that the classic male heart attack. This. My mother had "several silent heart attacks" with in a maybe 18-24 month period of time &was being treated for asthma by a pulmonary specialist. I have allergy related asthma and knew what she was experiencing was not asthma. I finally pitched a fit & made them hospitalize her. Sure enough, all those asthma attacks were heart attacks. |
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Post by anneinwa on Jun 6, 2017 21:30:25 GMT
Bloodwork would not show a heart attack is coming. The markers used are proteins released by damaged muscle tissue. An EKG would show ischemia (narrowed blood flow) or infarction (blocked blood flow with heart muscle damage). Serial troponins are blood tests that would show a myocardial infarction as/after it's happening, coupled with EKG changes. You'd have to know troponin levels for both visits, as well as what the EKGs showed, interpreted by someone knowledgeable--not just what the machine predicts and prints. ETA troponin is not the only marker used, but it is the most specific to myocardial (heart muscle) tissue. It will start to rise about 2 hours after a heart attack and is usually measured on admit for chest pain, again in 2 hours, sometimes in 2 more hours, and usually every 8 hours x 3. If she came in for something totally unrelated it's unlikely that any cardiac markers were drawn. Troponins usually peak in 24 hrs but can stay elevated for a week or two. You have to have more than one drawn to see the rise and fall pattern to know about when the onset was, if the heart attack was silent. So the Troponin level might have shown something if it happened between Monday and Thursday but they either didn't test it or it happened long enough before that it didn't show anything. |
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Post by Zee on Jun 6, 2017 21:37:07 GMT
Correct.
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Post by bearmom on Jun 6, 2017 21:38:22 GMT
Ok thanks. Figured it was a long shot. In the end it doesn't really matter but I am curious when it happened. CT was done the first visit (they wanted X-ray but I asked for CT to look at something else at same time so I didn't have to take her out the next week for an ultrasound. They did a ekg the second visit but not the first time. It is likely the the heart attack occurred after this EKG. Heart attacks are usually noticeable on an EKG. |
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Post by anneinwa on Jun 6, 2017 23:06:04 GMT
Ok thanks. Figured it was a long shot. In the end it doesn't really matter but I am curious when it happened. CT was done the first visit (they wanted X-ray but I asked for CT to look at something else at same time so I didn't have to take her out the next week for an ultrasound. They did a ekg the second visit but not the first time. It is likely the the heart attack occurred after this EKG. Heart attacks are usually noticeable on an EKG. I think the ekg was ordered after they saw something on the X-ray and the echo was done the next day by the time I got back to the hospital. She went in for one issue and was admitted for CHF suspicion I am assuming based on X-ray and ekg? |
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Post by mcscrapper on Jun 7, 2017 6:28:15 GMT
While a troponin test is pretty much the gold standard for testing for an MI, there are some causes for an elevation in the trop that are not cardiac related. An elevation in troponin can show up in the blood for up to about a week. After a week, it might be elevated but it may be on the way down from where the patient started. The peak with occur within about 24 hours. This is why the patient will have several blood draws throughout the day.
We are also looking at EKG changes and an echo can also help determine any damage in the heart but may not always be 100% in determining an MI.
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Post by anneinwa on Jun 7, 2017 15:07:25 GMT
While a troponin test is pretty much the gold standard for testing for an MI, there are some causes for an elevation in the trop that are not cardiac related. An elevation in troponin can show up in the blood for up to about a week. After a week, it might be elevated but it may be on the way down from where the patient started. The peak with occur within about 24 hours. This is why the patient will have several blood draws throughout the day. We are also looking at EKG changes and an echo can also help determine any damage in the heart but may not always be 100% in determining an MI. The troponins could've been elevated simply because of heart failure. It's a vicious circle. Did she go into failure because of the MI or does she have a history of it? With the dementia and assuming, unable to provide accurate history, it's very difficult to diagnose sometimes. ETA: so what I'm saying is...the physician could have ordered those cardiac markers and thought they were elevated based in her heart failure, until echo and EKG confirmed MI. She just had a pace maker put in in April. We were working with a cardiologist due to bradycardia for over a year and also found she was in a fib with pauses. This was about a year -year and a half. And they waited until until the benefits of the pace maker out weighed the risks with her. Aside from these issues nothing else was ever said about her heart (and I am primary caregiver when it comes to medical so wasn't like she wasn't passing information on). |
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smcast
Drama Llama
Posts: 5,307 
Location: MN
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Post by smcast on Jun 7, 2017 17:48:45 GMT
I'm glad you are there for her and getting her the treatment she needs.
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