« What a Catch! »: A Case Report on Denial and Myocardial Infarction

Abstract

Coronary disease has long been associated with different behavioral patterns (Pattern A, D) and denial mechanisms. Denial can take various forms that put the coronary patient at risk during the whole course of his illness [1,2]. Objective This case shows to what extent denial mechanisms can interfere in the relationship between some coronary patients and their caregivers. Case Presentation Roger, - now deceased - would have been 95 this year and had two heart attacks. His first infarction was anteroseptal, while his second was an inferior infarct. He suffers from coronary disease and has a history of unstable angina. He had a double coronary bypass (saphenous vein graft on left anterior descending artery and right coronary artery.). Heart wise, when we met him, he was currently symptom-free but presented a dyspnea of grade II to III. He denied any ongoing chest pain even during moderate effort. We assessed Roger in the context of his heart surgery. We met him in Intensive Care Unit both before and after the intervention. During the postoperative phase, he described his second heart attack. He really enjoyed telling us the story of his second infarction, which occurred while he was already on antianginal medication (i.e. Cedocard®). It all started while he was angling during the weekend. Roger had been fishing for several hours but had not caught anything. He was upset and about to leave (Pattern A typical impatience) [1-3] when all of a sudden, he felt his line snapping tight for a split second: a line bite! The trout was, allegedly, huge, and his fishing rod was too light to land the fish in one go. Being a strategic angler, Roger decided to wear the fish down and to slowly bring it back to shore so that he could scoop it with his landing net. While doing so, he felt the first angina pain occurring and persisting. He tried to reach for his tablets in his pocket but could not manage as his hand was already benumbed. He explained: « At that stage, I told myself: Roger, it’s you or the trout! » Well, he went for the trout! He landed the fish first (after a one-hour struggle) and only then agreed to go to hospital in emergency (if this term remains appropriate in such a context).