Cellulitis and Heart Attack in 33 year old

[Art Shirk]

Not sure if anyone will have info on this but wanted to toss it out there.

A good friend of mine returned from a BC fishing trip about a week ago and upon returning, he felt horrible. Flu-ish, lethargic, etc. Eventually, he could barely get out of bed and his wife then whisked him to the hospital. They stated that it was Cellulitis, likely bacteria from handling fish and started him on a heavy regimen of antibiotics. Severe enough that he had to remain in hospital. A day or so into his visit, he started complaining of chest pains. The doctors continued to monitor him, told him they didnt see anything alarming and let him be. 16 hours of chest pains later, they reported to him that he had had a heart attack.

The dude is 33, pretty damn fit, not overweight, no prior heath issues. The doctors are claiming that it was not at all associated with his cellulitis. The pessimist I am, I think they may be trying to cover their asses. I almost want to drag him out of the hospital he is at and relocate the guy. He is still there, feeling horrible. His wife, my good friend as well, is clearly freaking out (especially as she has a doctor's appointment today to learn the sex of their second child...a visit that I wish he could be there to attend).

I guess I am just wondering if people share my concern or what you would suggest to him moving forward. Probably not my place to intercede, but I feel kinda helpless and I am sure he does too.

[PB]

warning: unqualified medical opinion to follow ......

The heart attack may or may not be related the the cellulitis - systemic bacterial infections can impact heart valves, but that usually manifests itself differently than a hear attack. The bigger issue is the 16 hours it took to diagnose the damn heart attack.

[summit]

As PB was saying, you could have some of the same agent that cause cellulitis (like staph. Sureus) end up causing bacterial endocarditis possibly in the form of vegetative growth on the left side valves that could embolize and possibly cause a heart attack, or mimic one with cardiac arteritis. Did your friend have a history of rheumatic fever? Congenital heart disease? Dental issues on the trip or recent dental procedures?

Notice, my unqualified opinion included could/possibly/could/possibly. It is possible. It is uncommon. So are heart attacks in 33 year olds. If it did occur, it isn't necessarily a screw up on the doctor's part unless they weren't treating the infection, or weren't properly working up his chest pain complaint. What did the doctor say caused the MI?

Sent from my TI-89

[skinnyskier]

Summit's got that one right. Cellulitis or worse a necrotizing soft tissue infection should be no secret-red angry patch of skin, underlying fat, fascia, muscle infected and dying etc. That could cause bacteremia and endocarditis. But an acute febrile illness with no clear source, and then an MI would be a little puzzling. If he had bacteria in the blood and a valvular vegetation on echocardiogram or a loud new murmur then we have to go with Summit's suggestion. He brings up a vasculitis, such as Takyasu's Arteritis, which I guess could also be considered. Could also have had viral myocarditis, I guess. Could have had shock and demand ischemia but that doesn't fit with the scenario.

I don't let my patients sit around with 16 hours of chest pains, even if the ECG and initial cardiac markers are normal. I'd get an echo, and if normal I'd be somewhat reassured. Even still we would often want to get folks on aspirin, anticoagulation, beta blockers, perhaps other antianginals if they persist with typical chest pains.

We need to know if the diagnosis of MI was made by elevated cardiac markers or by ECG changes, and what they were. We also need to know what the echo showed, and preferably see the images, and know if he had any positive blood cultures.

[Art Shirk]

I don't let my patients sit around with 16 hours of chest pains, even if the ECG and initial cardiac markers are normal. I'd get an echo, and if normal I'd be somewhat reassured.

This is what it boiled down to for me. And I should note that every hour of his chest pain was conferred to his Attending. I very much appreciate the input and cannot thank you guys enough to take the time to read my post and respond with a thoughtful answer but much of it is Greek to me. Based on the new questions posed, I think I am out of my entitlement to ask for the answers so I am afraid that I have to just wait and hope for the best for my friend. If I could provide images, echo results, blood results, etc, I would. Just scared for a good family in what I think is such an odd situation.

Thanks guys.

[haydukelives]

Thanks to regulations from the feds, I am surprised that his MD's were even allowed to talk to you.
Maybe you could ask his wife to be sure he has all the right specialists on the job,including a real cardiologist and ID expert

[skiJ]

pm sent --

hang In. Good luck ... J

[PNWbrit]

Nothing to add but best wishes to you and your friend Mark.

[Art Shirk]

Much thanks for the thoughtful and informed PM skiJ, and thanks Rob for your wishes. Whacky stuff, this. Haven't had much good news from his medical crew recently but I am optimistic that I will be sharing a beer with the guy sometime this summer if I have to sneak past the nurses.

[Art Shirk]

Resting at home finally. Thanks for all the insights. Think it is only up from here.

[My Pet Powder Goat]

Good to hear your friend is doing better!

[skinnyskier]

Happy news!

[Art Shirk]

Thanks! Amazing how you can be so down and then the human body and medical science just take over you things turn around. Hopefully it will just all be a story one day, when it previously seemed so desperate.

[skiJ]

Thanks for the Update --

sounds like it was a scary week .


Onward ! Good luck ... skiJ