About 1-2 months ago now, we saw a new patient. She came to us with complaints of feeling short of breath after getting food poisoning. She also had a non-productive moist cough with wheezes. Her vital signs were normal with a moderately elevated blood pressure (159/87) and good oxygen saturations. Being that it all initially began with food poisoning we asked about on-going GI issues. But she had had none. Her appetite was good and no problems with elimination. Hhhmmm. Probably no lingering effects of the food poisoning but just in case…
Can you describe why you thought food poisoning? She described bad epigastric (middle upper abdomen) pain and cramping with feelings of nausea and weakness. No fever. No diarrhea. No vomiting. The issues resolved within 24 hr and she has had no GI concerns since. This happened about 1 month prior to her visit to us. No medication allergies and no significant medical history. No history of heart or lung disease, diabetes, or hypertension (high BP). Hhhmmm. Probably not food poisoning then though this still is an outside chance. What else can give her this pain and these symptoms?
Perhaps a pneumonia or the like. Her lung sounds had crackles in the right base and percussing over the lung fields resulted in positive dullness (fullness in lungs). Her hear rate was regular without murmur or gallup. No edema in extremities or third spaces on assessment. CXR showed bilat pleural effusions with fluid as shown by both standing and recumbant positions, and a very mildly enlarged heart. Hhhmmm. So why the fluid in her lungs? Usual suspects: infection and heart issues. But she had no fever and this has been going on for over a month. Perhaps the pain was pericarditis?
Ultrasound showed no changes in abdominal organs (particularly spleen and liver) and minimal to absence of fluid in the pericardial sack. So did not appear to be pericarditis. Hhhhmmmm. We should have the lab results by now. What do they show?
Lab work came back with normal kidney function and electrolytes, normal total protein, mildly elevated liver function tests, normal blood count including WBC (white blood cells), and negative for HIV and HepB. However, her CK-MB and LDH were both elevated. She denied seeing any signs of jaundice immediately after the “food poisoning” episode, which we now did not believe to be food poisoning at all. Hhmmm. Elevated cardiac enzymes?
EKG showed changes in several leads and was repeated to confirm findings. Ah-hah! She had apparently suffered anterio-septal myocardial infarction (“heart attack”) a month ago and her heart was beginning to show mild signs of failure–mildly enlarged, fluid in the lungs causing shortness of breath. Women usually do not show the classic MI signs that men do. I have heard of women having quite varied symptoms and one person as little as pain in their left pinky finger! Because the pain was right under her lower ribs and she had just eaten out at a restaurant, she had concluded it was food poisoning and since it resolved relatively quickly, she assumed that that is all it had been.
We put her on an aspirin daily, a nitrate and diuretic to make her more comfortable and an ACE inhibitor to help keep her heart stable until she could be seen by the cardiologist. Right there, we had her family help her arrange flights for the next day to the capital city and our doctor sent along the results of our studies today and a referral for the cardiologist.
We have since had 2 follow-up appointments with her. At the cardiologist’s she was also diagnosed with tuberculosis and is now on a 6-month treatment for that disease. He has also put her on several medications to help ease the workload of her heart and give her greater ease in breathing. We also added Nitroglycerine tablets should she experience any further chest pains.
Even when giving her this shocking news you could tell she was overwhelmed but remained so sweet and kept expressing her gratitude that we found the problem. We are so happy that she was able to get right to the cardiologist and begin appropriate treatment that will help extend her life quite a bit. Thank the Lord for doctors!!!!