Sample Chronology

December 28th: Ann Jyna, a sixty year old African-American female, was preparing her home for a holiday party and experiences chest pain. She rests and takes one of her husband's sublingual nitroglycerin with partial relief of symptoms. Ann has never experienced angina before and spends the rest of the day in her recliner chair.

Warning: Unstable angina is often the intermediate stage between stable angina and heart attack. Of all major ethnic groups, African American women face the highest risk of death from heart attack. Sedentary people are almost twice as likely to suffer heart attacks than those who exercise regularly.

December 29th: Upon urging of children, Ann calls her internist to make an appointment. After explaining her situation, she is told, "We are closed for the holiday and don't have an opening until January 2nd." Ann takes the appointment.

Warning: Women often take the role of caregiver, delaying medical treatment longer than men.

December 31st: Ann experiences nausea and pain between the shoulder blades. Her children insist she go to the hospital to be seen. Her vital signs are" blood pressure 146/98, heart rate 92 bpm, respirations 22, temperature 37 degrees Celsius. She is placed on oxygen and an EKG is done by a telemetry technician who tells her there are "no changes." The ER resident glances at the EKG and her chart and says, "I don't see anything to worry about." He tells Ann to "take it easy and see (your) family doctor soon."

Warning: Hypertension, defined as blood pressure of 140/90, has been proven as a cause of coronary artery disease. The ER doctor had no previous EKG to compare the current one with to determine subtle changes. Furthermore, between 25-50% of patients who have angina have normal EKG's. Ann should have been admitted, seen by a cardiologist, had serial cardiac enzymes drawn (labwork drawn over a period of 24 hours, indicating cardiac muscle death) and further evaluation should have been done.

January 1st: Ann has intermittent discomfort attributed to "gas." She looks forward to her appointment in the morning.

Warning: Men often have "classic" angina, described as 'an elephant sitting on my chest.' Women more often have gastrointestinal and "vague" anginal equivalents, making it more difficult to treat.

January 2nd: Ann sees her doctor. He gives her a prescription for Prilosec and tells her to "take it easy." No EKG or lab work done.

January 4th: Ann has been taking the Prilosec, but experiences left arm and jaw discomfort. Her daughter calls the family MD and is told by the triage RN, "sometimes the medicine takes awhile, keep taking it a few more days." Warning: Jaw and arm pain are likely indicators of a cardiac "event."

January 6th: Ann is found by her husband, diaphoretic (sweaty and cool) and unresponsive in her recliner chair. He calls 911 and Ann experiences cardiac arrest en-route to the hospital. Efforts were unsuccessful to resuscitate her and Ann is pronounced dead on arrival at the hospital.