What a beautiful weekend! Shame I’ve been on-call all week and it’s been very busy. At the end of on-call weeks I often like to write my blog on an interesting case I’ve seen, and try to tease out any learning points that are of value to the public. Today is no exception, but there is a very personal story to me at the end.
Joe (not his real name) is a few years younger than me in his early 40s. He’s a bit overweight, but had no major medical problems. He had been feeling a bit breathless for a few weeks, and finally got some indigestion like pain which prompted him to see his GP. His GP did an ECG (paper tracing of the heart) which was quite abnormal, and he had some fluid on his lungs when he listened with a stethoscope. He referred him to our hospital and I looked after him on the coronary care unit, where it turned out he had uncontrolled high blood pressure, heart failure, and the worst coronary artery disease in a man of his age I’ve ever seen. There was actually a moment or two when I thought he wouldn’t survive. Thankfully he responded really well to treatment and has now been discharged, but I mention it here just to highlight how in a young person, they can often compensate (this is the medical word) for a long time before the wheels really fall off very quickly. Unfortunately the long term outlook remains less than ideal, but at least he is now on the right medication to help. We are seeing younger and younger patients with coronary artery disease these days, in fact he wasn’t the youngest I saw even this week! Everyone should know their blood pressure, and their cholesterol…
Bob (also not his real name) had previous heart surgery, and heart failure, but despite that was really pretty good. He hadn’t been able to shake some chest infection symptoms for some weeks though. He was actually brought into hospital though due to a blackout. I initially wondered if this was due to a coughing fit (so called cough syncope) but after speaking with his wife that didn’t really fit. I kept him in for observation, and it wasn’t until 03:30 the next day when the diagnosis became clear. His heart stopped completely, and he needed resuscitation. I’m not called in all that often in the middle of the night these days but this was one such time, and I put a pacing wire into his heart to stabilise things. I suspected at that point that there was more to this that initially thought, and so it proved. I did a scan which showed an abscess by his heart valve, right at the spot which conducts electrical activity from the top to the bottom of the heart, which was why his heart stopped. It’s a rare but important complication of heart valve infection.
My last case is not heart related at all. I bumped into a good friend in the hospital with his wife a week ago, and it turned out he was there for some blood tests. He had been bruising easily, and the initially blood test at his GP showed a low platelet count (these are the things in our blood that help form clots). The next blood tests were inconclusive, and to get a better idea of the problem the specialist performed a bone marrow biopsy. The bone marrow produces the components of the blood, and so is the best way to understand the cause. I’ve just spoken with my friend today, and unfortunately the biopsy showed a rare form of leukaemia. Thankfully it is one that apparently has a good prognosis overall, but nevertheless they will need chemotherapy and all that that entails. He is very upbeat, and we spoke about how this might change his life. Interestingly, he said not all that much in terms of outlook, as he has always lived his life as if there may be something nasty around the corner, and made the most of any opportunity that came along.
I couldn’t agree more and have the same outlook. None of us have a crystal ball, but being mindful and intentional about how we live our lives is a skill, and one we could all do with practising. Thank goodness he sought advice, and hopefully has a good outcome. My thoughts are certainly with him today.
In this week’s video, I discuss the evidence for blood pressure treatment specifically with respect to dementia risk, with some new trials having caught my eye. Have a great week, and use plenty of sunscreen it’s going to be a hot one!