Yet again, an example of sexism in cardiology! To be fair, though, I have seen signs that it is improving.
Another point, HT, is that with blood sugars this high, I am under the impression that this woman is a diabetic. Diabetics, either male or female, frequently don't have chest pain because of neuropathy. Should she have been taken to cath lab immediately? Of course. Or at least when her first set of markers came back. I am just not used to treating MIs with lytics. Coming from a large metro hospital with a huge cath lab, the only time I see lytics used for MIs is if the patient is brought in from a rural hospital. They are proper treatment, though, if a cath lab isn't available.
As for the lactic acidosis, it is
very ominous for heart patients. I'm not sure what your docs meant by there being three different types of diabetic acidosis, but high lactate levels are dangerous. In this case your patient was getting a double whammy. Ketoacidosis uses up bicarbonate which creates the initial acidosis, but the compromised myocardium also wasn't efficient at pumping the blood to get oxygen to the tissues, creating an anaerobic state. Anaerobic glycolysis only produces 60-70% of the energy of ATP and reduces a muscles ability to maintain the sodium-potassium pump. Sodium builds in the cells reducing the amount of calcium that can flow in and increasing the outflow of potassium, decreasing contractillity, which decreases the heart's ability to get oxygen to the tissues. The potassium leached from ischemic tissues causes hypopolarization which leads to calcium shifts which may lead to disrhythmias.
Glycolysis also leads to an increase of lactic acid, which worsens the acidosis already present from the ketoacidosis and continues the above vicious cycle. Acidosis will further increase the damage to the heart by making it more vulnerable to damage from lysosomal enzymes.
Is that sort of the answer you were looking for? I'm on a different sleep schedule right now, so I'm not sure if I'm making sense.
One thing I love about this BB is that I am able to continually learn. Believe me, I didn't spit all that out from memory ... people ask questions and I go right for my books and look it all up. Hopefully, in the research and explaining, I get to learn more too.
I've only been doing this for three years, so if anyone has something else to add, please do!