24th day - Curiosity kills the cat, only if the cat is stupid

Today was a biochemistry small case study group. Here, we are given case studies, but have to apply biochemistry concepts to solve and diagnose it. Simple stuff. However, not so simple when I ask a question about the "why". We had 2 cases, both dealing with heart attacks. I solved all the questions with ease, but after the session was over, I asked a simple question, "In case 1, why did the patient feel the chest pain for the first heart attack and not the chest pain for the 2nd one?". The teacher said that the first one was due to ischemia which caused some pain. This result caused more cells to die, leading to another heart attack. That is, the 2nd heart attack was not due to ischemia and that is why she didn't feel pain. This was the wrong reason and I proved her wrong. We were given a graph analyzing her serum and after a heart attack, there is a sharp peak of CK-MB. After two days, these CK-MB levels return to baseline and then she has her 2nd heart attack where the CK-MB levels peak again. If the 2nd heart attack was not due to ischemia and due to cells continually dying from the 1st ischemia, then the CK-MB levels would be constantly increasing after the 1st peak, but they were not. They were decreasing! She agreed with me and we went to the biochemistry course director to ask this question. After a lot of talking, the biochem prof. said "you will encounter many things in medicine that you will not know the answer to."

I wasn't exactly happy with this answer, so I went to the anatomy course director later. I showed him the case and asked him the question. He gave me a looong speech about how there are many cases wehere people are healthy and get sick suddenly. This does not answer my question. Eventually, he admitted he does not know the answer. I had my own theory on this that had to do with neuroscience.

My theory was that sensory fibers of the heart that carry pain sensation are sympathetic fibers and they normally cross in the chest OR arm. In the 1st heart attack, the area of the heart that died had sensory fibers crossing to the chest wall, while in the 2nd heart attack, it was an area that the sensory fibers carried to the left arm. This was just a case study, so I couldn't ask the patient if she felt any pain in her left arm, but most likely she did. This was my final answer and it made sense to me. I think a neurology prof. would have reached the same conclusion, but I don't have anymore time to run around and ask more profs.

In class today, I actually sat with the FTM crowd, but it was with the good people. It was nice, I had a nice conversation with them.