Randi Marchant, a 42-year-old waitress, was vacuuming the family room when she felt that painful squeezing in her chest again. This was the third time today, but this one really hurt. She sat down to catch her breath and stubbed out the cigarette she had left smoldering in the half-filled ashtray by the couch. Randi’s husband, Jimmy, and stepdaughter, Melonie, pestered her until she finally took time off work to see her doctor. Dr. Harris found that her blood pressure was 158/88—probably owing to the noon rush stress at work, she rationalized. At least her cholesterol test was only 30 points above average this time. It had been slowly coming down, even though she was having a hard time following the DASH diet her doctor wanted her to follow.

Question

Another wave of pain tightened its icy fingers around her heart and moved up into both sides of her jaw. Randi thought, “Probably just a little acid reflux. Since the pain doesn’t radiate down my left arm, it couldn’t be my heart, could it?”

“Don’t think about the pain,” she told herself. “Think of something else. For dinner tonight, I’ll make --” Randi fell to the floor, clutching her chest, just as Melonie walked in. She saw her stepmother slumped on the floor and screamed, “Help, somebody, help!”

Answer all 4 of the questions below in your post.

What information in the story indicates that Randi might be a candidate for heart disease?
Discuss why Randi thought this was not a heart attack.
What can Melonie do immediately to try to save Randi’s life?
Assuming that Randi is suffering a myocardial infarction, discuss why it is important that she receive appropriate treatment quickly.

Answer 1

1. What information in the story indicates that Randi might be a candidate for heart disease?

Several pieces of information in the story suggest that Randi might be a candidate for heart disease:

• Age: At 42, Randi is at an age where the risk for heart disease begins to increase, especially for women, particularly after menopause.
• Symptoms: Randi experiences recurrent chest pain described as a "painful squeezing" in her chest, which is a classic symptom of heart issues. The pain also radiates to her jaw, which can be indicative of angina or a heart attack.
• Smoking: Randi smokes cigarettes, which is a significant risk factor for cardiovascular disease as it contributes to arterial damage and increases blood pressure.
• Blood Pressure: Her blood pressure reading of 158/88 is elevated, indicating hypertension, another significant risk factor for heart disease.
• Cholesterol Levels: Although her cholesterol level is only 30 points above average, it indicates that she may have issues managing her cholesterol, especially since it has been slowly coming down as per her efforts to follow a health diet.
• Stress: Randi notes that her blood pressure may be high due to stress from her job as a waitress, which could contribute to wear and tear on her cardiovascular system.

2. Discuss why Randi thought this was not a heart attack.

Randi rationalized her symptoms as something less serious than a heart attack for a few reasons:

• Self-Diagnosis: She initially attributed her pain to "probably just a little acid reflux," suggesting that she was anxious to dismiss the pain as something benign rather than a severe cardiac issue.
• Symptom Analysis: Randi seems to believe that because the pain did not radiate down her left arm—a common indication of heart attack—this somehow ruled out the possibility of it being heart-related.
• Psychological Coping: During moments of distress, individuals sometimes engage in denial as a coping mechanism, attempting to shift their focus away from alarming physical symptoms. Randi attempts to distract herself by thinking about dinner, suggesting she feels that the pain doesn't warrant concern.

3. What can Melonie do immediately to try to save Randi’s life?

Melonie should take the following immediate actions:

• Call Emergency Services: The first and most important step is to call emergency services (911 or the local emergency number) to get professional medical assistance on the way.
• Check Responsiveness: Melonie should assess Randi's responsiveness. If Randi is unresponsive, Melonie should ensure that Randi is in a safe position (ideally on her back) and check for breathing.
• Perform CPR if Necessary: If Randi is unresponsive and not breathing, Melonie should begin CPR immediately. This involves chest compressions (30 compressions followed by 2 rescue breaths) to keep blood circulating until help arrives.
• Use an AED if Available: If there is an Automated External Defibrillator (AED) nearby, it should be retrieved and used as per the device's instructions to restore a normal heart rhythm if Randi's heart has stopped.

4. Assuming that Randi is suffering a myocardial infarction, discuss why it is important that she receive appropriate treatment quickly.

Rapid treatment for a myocardial infarction (heart attack) is crucial for several reasons:

• Tissue Damage: The heart muscle requires a constant supply of oxygen-rich blood. If a coronary artery is blocked, the affected heart tissue will begin to die (necrosis) within minutes due to a lack of oxygen. Quick treatment can help restore blood flow and minimize damage.
• Survival Rates: Survival rates improve significantly with timely intervention. The sooner Randi receives appropriate medical treatment, such as medication to dissolve the clot (thrombolytics) or procedures such as angioplasty or stenting, the better her chances of recovery.
• Long-term Health: Quick treatment can reduce the risk of complications, such as heart failure or arrhythmias, that can arise from a heart attack. The quicker the intervention, the better the long-term prognosis for Randi’s heart health.
• Quality of Life: The effectiveness of treatment can influence Randi's quality of life post-recovery, determining her ability to return to her daily activities, manage any underlying conditions, and reduce future cardiovascular risks.

Timely medical intervention is essential for reducing morbidity and mortality associated with heart attacks.