Please help me answering questions 1-6 for this clinical case. A 61 year old AAF

Question

Please help me answering questions 1-6 for this clinical case. A 61 year old AAF was admitted to the hospital with a worsening of abdominal pain, upset stomach with heartburn, nausea, and vomiting. The pain and symptoms started 2-3 days ago. The antacid medication made her well until the morning of this day. Physical examination shows tenderness of the RLQ of the abdomen, but soft and no rebound. An ECG shows numerous abnormal beats and marked deviation of the segment S-T. CPP was positive, showing troponin elevation, cardiac CK (creatine kinase), in addition to elevated blood glucose levels. Shortly after admission, she suffered cardiac arrest and died. Questions 1. What is your diagnosis? Diverticulitis, Appendicitis, etc? 2. How is your diagnosis based on the physical examination and ECG? 3. What do the lab data demonstrate? 4. What has caused the cardiac arrest? 5. Are the starting and course of the disease typical or not? Explain. 6. Is it true that there is a "cardioptosis of old age"? The heart migrates down towards the abdomen with age.

Explanation / Answer

1)Women may experience fewer typical symptoms of myocardial infarction than men, most commonly shortness of breath, weakness, a feeling of indigestion, and fatigue.
Symptoms More Likely in Women
* Indigestion or gas-like pain
* Dizziness, nausea or vomiting
* Unexplained weakness, fatigue
* Discomfort/pain between shoulder blades
* Recurring chest discomfort
* Sense of impending doom
What many people, including many healthcare professionals, don’t realize is that the symptoms of heart attack in women are often different. She might have died due to second heart attack.

Diverticulitis, Appendicitis, etc

Signs and symptoms
Patients often present with the classic triad of left lower quadrant pain, fever, and leukocytosis (an elevation of the white cell count in blood tests). Patients may also complain of nausea or diarrhea; others may be constipated.

The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, then nausea, vomiting, feeling hot while having no fever, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications. Diverticulitis worsens throughout the day, as it starts as small pains and slowly turns into vomiting and sharp pains.

Treatment
An initial episode of acute diverticulitis is usually treated with bowel rest (ie, nothing by mouth), IV fluid resuscitation, and broad-spectrum antibiotics which cover anaerobic bacteria and gram-negative rods. However, recurring acute attacks or complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis

2) AND 3)ECG and lab data strongly suggest massive myocardial infarction, since no other data are available.

4)) cardiogenic shock

5))not typical, but i have seen many cases with misleading symptoms and the final diagnosis will be cardiac origin,

6))not prooven.The heart migrates down towards the abdomen with age.

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