Per Mr. Markle’s supposed heart attack: This explanation may be long, but I felt the need to write it out in detail so that everyone can understand why the story is full of logical fallacy.

Myocardial infarction, commonly known as heart attack, is actually a part of a broader spectrum called coronary artery syndrome. Coronary arteries are blood vessels that supply oxygen and nutrients to the heart. They can be compromised by atherosclerosis (building of plaque along the walls) or by acute rupture of these plaques. When coronary arteries are narrowed under such circumstances, blood supply to the heart is reduced. Depending on the degree of blockage, a variety of symptoms occur, all of which are part of coronary artery syndrome.

If the blockage is relatively minor, angina (chest pain) occurs. Angina can be further divided into two categories depending on their characters. The most significant difference between the two is whether the chest pain occurs at rest.

If the chest pain occurs with exertion (such as exercise or emotional distress), it’s called a “stable” angina; such pain lasts less than 10 minutes.

If the chest pain occurs at rest, is new, or is increasing in intensity, it’s called an “unstable” angina. Such pain lasts between 10 to 20 minutes.

After stable angina and unstable angina, we approach myocardial infarction (MI=heart attacks) part of the spectrum. Unlike angina, a heart attack is accompanied by an increase in cardiac enzymes. These enzymes are substances that are supposed to be WITHIN the heart cells. The fact that they’re shown to be increased on the blood test means that the heart cells were damaged enough to release them into the bloodstream.

Myocardial infarction can be divided into two types depending on the result of electrocardiogram (ECG or EKG). If a normal EKG is accompanied by increased cardiac markers, it’s an NSTEMI (Non ST-segment Elevation Myocardial Infarction). If the EKG does display a sign of heart attack (an ST-segment elevation), myocardial infarction is called STEMI (ST-segment Elevation Myocardial Infarction).

So coronary artery syndrome is a spectrum of stable angina, unstable angina, NSTEMI, and STEMI. Now that I explained the basic terminologies, allow me to walk you through the story.

By Mr. Markle’s story of “experiencing heart attack 6 days ago,” I’m logically deducing that he experienced chest pain severe enough to call 911, visit a physician, or be admitted to the ER. Whenever a patient comes in complaining of chest pain, the standard protocol dictates that a physician or an EMT acquires a 12-lead EKG of the patient. If the EKG shows an ST segment elevation, it’s a STEMI. If the EKG is normal, blood tests need to be done to determine the cardiac enzyme levels; if they’re increased, it’s an NSTEMI; if they’re normal, it’s an unstable angina.

The fact that Mr. Markle apparently experienced a heart attack means he either experienced STEMI or NSTEMI. Regardless of the EKG results, heart attacks require further work up with blood tests and coronary angiography. Coronary angiography is an invasive procedure, because it involves a catheter climbing up through your arteries to your heart then radiocontrast dye being injected in the arteries so that the cardiologists or interventional radiologists can view them.

Depending on the blockage and the vessel quality, the physician may then decide to place a stent in the blocked artery. Stents are basically straws that widen narrowed arteries. One of the complications of these procedures is that atherosclerotic plaque may rupture. An easy way to view these plaques would be to think of them as scabs. If you keep picking at your scabs, they would fall off, right? It’s the same with these plaques. These plaques may be narrowing your arteries, but if you pick at them with these procedures, they may fall off too; but instead of them falling into the ground like scabs do, these ruptured fragments travel further down the bloodstream and block arteries elsewhere, causing stroke if they block arteries to the brain or another heart attack if they block a coronary artery downstream. With these dangerous complications, it’s no wonder that the patients are strongly advised to notify their family members or friends with the medical power of attorney of their circumstances. Also, many patients are admitted to the Coronary Care Unit (CCU) after the procedure for observation for at least overnight.

This virtually universal protocol raises some questions:

If Mr. Markle indeed had a heart attack nearly a week ago, didn’t he receive standard treatment? If he did, wasn’t he admitted to the CCU? After all, he’s likely to have diabetes and hypertension with his obesity; I doubt he stayed only for an overnight. So where was his daughter at this time? She either knew but chose not to go or couldn’t go. If she couldn’t go, why couldn’t she go? The least damaging excuse of her absence would be that her father refrained from telling her to keep her from worrying; but this would only lead to more questions, because it means that no one in her family bothered to tell her that her father could be in his deathbed. When were they going to tell her? After the complications arose? After the doctor signed the death certificate? Such conflicting behaviors mean that either Ms. Markle is not close to her father or she is neglecting her own father. If she’s not that close to her father, her wedding narrative falls apart; if she’s abandoning her father, well…

The counterargument for an alleged episode of MI would be his apparent picture of health from the paparazzi recently. While he could be flat out lying, the best explanation I can come up with would be that it wasn’t STEMI or NSTEMI that he suffered; it was angina. He experienced some chest pain, had some work up done, and learned that his coronary arteries were compromised, which I wouldn’t find surprising. Then, he or someone else chose to exaggerate the matter to greater proportions than needed to garner sympathy or for financial gain.

Like I said, this story is full of holes once you look at it from the medical point-of-view. The questions raised shouldn’t only be why she ISN’T there, it should also be why she WASN’T there.

Thank you this is fantastic, like ICURN you both are on target. 💖💖💖

Advertisements