Sunday, 26 July 2009

Chest Pain - Part II

I was always taught that a patient presenting in an ER with a medical problem needed to leave the consultation room with a working diagnosis...perhaps not always something specific,depending on the experience of the doctor or nurse,but at least with a ballpark idea...

(Unlike in trauma where I can tell you have a mild head injury because I've just helped strap you down to the trolley to have that axe removed from your skull by a neurosurgeon)

I will often...(frequently)...say something like this to a patient:-
"Well...I can't find anything sinister...all your tests are normal...but you do have all the signs and symptoms of a viral pharynx,red ear drums,mild viral rash...and you also feel better since the triage nurse gave you the paracetamol an hour ago."

And then I say, "I'm happy to get you an appointment at your GP if you would like...or ,you can go home and do the 'watchful waiting' thing...if anything gets worse or changes...come back or go to your doctor."

I know my limitations,-professional at any rate-,and I don't believe that patients trust someone who cultivates an air of supercilious mystery who doesn't take their concerns worst.

Patients seem satisfied with this response...I personally get a lot of 'repeat business'...

And I sat on my couch for three days at home,with continuing ectopic beats ,and feeling short of breath,I wondered if that was just something they teach in centres where patients have to pay at point-of-treatment rather than at point-of-taxation?

I cannot imagine going to consult a self employed health professional in Johannesburg,-where you or your medical insurance pay up front for the consultation-,and not receiving a diagnosis or an immediate referral.

Now I accept that things change...but let me give you just two examples from this year. In May I had to consult a dentist in Jo'burg when I had a problem with a filling which needed filing down...not only was I seen within four hours of attempting to get an appointment;I was also seen on time;and because the treatment only required probably three minutes work,the dentist also threw in a free scale and polish.I also had to take my dad to see a neurologist...who also saw us on time...did a thorough examination...gave us her diagnosis and a treatment plan...and asked us if we were happy with what we had been told.

Saturday I went back to work my scheduled shift at the Unit.The rate and intensity of the ectopics' had somewhat diminished although they were still present...

At about 0900 I started to feel unwell...short of breath...became hypertensive with a BP of 210/160 and sats of 95%...and a feeling like a trip hammer in my chest.

So my colleagues bundled me into an ambo and sent me back to St Vulvas'...

...where Grumpy,-the mad Scots ER Consultant-,started to moan at me about coming to "his" Unit rather than going to see my GP...


However...since he knows me...and saw me being wheeled in by the Paramedics,he at least had the grace to examine me immediately...and then...when I said that I was happy to go privately to see a specialist,had the courtesy to immediately refer me to the on-call consultant Cardiologist...on the NHS...(as it were:really glad I pay 40% tax)...

...who also knew me...he listened and prodded and agreed that the time between the end of the ectopic beat ,and the beginning of the normal beat ,was 1.5 seconds...a relatively long time in my chest since I have a normal resting heart rate of 74...slightly more than 1 beat/ I was having a gap of 1.5 seconds between beats...and I can physically feel it...

...and after a thorough examination including repeating my trop...(which was normal on Tuesday-although I was told by the SHO that she hadn't done it)...he came to the following conclusion:-

I have a virus!!

Or possibly have had a PE sometime in the last two months.

So I am booked for a stress test on Wednesday (hopefully) and then for a VQ scan.

So I went home and took an aspirin.
Or two.

And as I speak,my colleagues are sticking pins in a voodoo doll representing me for abandoning them for the weekend....ouch....another aspirin please!

Cartoon from as always


  1. garlic is a good anticoagulant.

  2. is there a blood test for pophyria? people from joburg tend to have it, especially if they are white.