Med-Fi: Chest pain in 2050

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Fiona was relieved to have got the all clear for her heart health – it had been an anxious few hours. At 70 years old and with a polygenic risk score that identified her as having a 34% annual risk of developing cardiovascular disease, there was always that lingering worry that a heart attack may strike. The gene therapy had managed to reduce that annual risk to 11% and the polydepot injection got it down still further to 3%. However, she knew that no primary prevention could be 100% effective – and 3% was still a risk that played on her mind.

Monday had been a particularly tough day. Being CEO of a virtual startup – a company within a company – was proving to be harder than she ever anticipated. She seemed to be never out of the VR meeting room. It hardly seemed like she was working from her remote coastal property at all.

Unfortunately, of course, while you can have whatever virtual identity and appearance you like in the VR meeting room, you can’t have virtual health. And Fiona’s chest pain felt very real. It gripped the central of her chest and throat like a vice. Fortunately, her clammy, grey complexion was picked up by the VR – and was easily recognised by her colleagues as a sign that something wasn’t right. They implored Fiona to call for help.

Fiona left the meeting room and called for the EMS (Emergency Medical Services) with voice activation. The smart computer immediately connected her to the EMS bot, which asked Fiona to describe her symptoms. It called up her medical records noting the polygenic risk score, the previous gene therapy, the active polydepot injection and all of the environmental risk factors. Today had been a particularly poor day for air quality in the area, which of course stepped up the cardiovascular risk.

The bot interrogated Fiona’s iMonitor – normal vital signs. Simultaneously it checked the iECG – the implantable ECG. Normal sinus rhythm throughout, no ST changes, no sign of ischaemia. Great. On to the next stage.

Fiona’s cardiovascular risk had made her eligible for an iDx-CV – implantable diagnostics, cardiovascular module. So far, things had been pretty steady – cardiac troponin had been at a good baseline of 2ng/L with just the odd bump up to 11 or 12ng/L after heavy exertion. Nothing unusual – and not really impacting on that 3% annual risk so far. NT-proBNP had been steady at 85-95pg/ml, D-dimer had remained at below 100ng/ml for several weeks now, the inflammatory panel showed little active inflammation at baseline while the Immucheck showed normal immune responses.

The bot ordered samples to be drawn by the iDx. It let Fiona know, but of course she couldn’t feel anything. The pain was settled and by now Fiona was already feeling pretty reassured. Ten minutes later, the report was available. None of the biomarker concentrations had budged significantly. The AI algorithm noted only a 3% probability of acute myocardial infarction, a 0.6% probability of aortic dissection, and <0.5% probability of other serious conditions.

Still, Fiona could do with some more reassurance. That chest pain had been pretty worrying. When the bot asked if she wanted to speak with a human doctor, Fiona jumped at the chance.

The doctor, Marc, was available by VR within 30 seconds. The first available on the NHS international scheme was based in France, but he spoke fluent English and had been trained on all the same systems. Marc took a look at all the reports, spoke with Fiona, ran a surface scan using the VR technology and took some further topical measurements via Fiona’s smart watch. Everything was in order.

Marc explained the situation to Fiona. He presented the options both verbally and by sending the personalised decision aid to her phone. Using the traditional shared decision making approach, they came to a mutual decision to leave well alone. Serial interrogations of the iECG, iMonitor and iDx-CV were programmed in for the next 3 hours, but if all remained well there would be no cause for alarm.

What a day. Fiona sat back. “Alexa, get me a G&T – better make it non-alcoholic today”. As the drone delivered her drink 10 minutes later, Fiona thought back to what had happened to her mum all those years ago. She’d had such similar chest pain. If only they’d had such great diagnostics back then. Perhaps her mum wouldn’t have caught COVID-24 in the crowded Emergency Department. They didn’t even have adaptive vaccines back then. Had technology advanced a little faster, perhaps she’d still be alive today.



Cite this article as: Rick Body, "Med-Fi: Chest pain in 2050," in St.Emlyn's, June 27, 2021, https://www.stemlynsblog.org/med-fi-chest-pain-in-2050/.

Posted by Rick Body

Professor Richard Body MB ChB, FRCEM, PhD is Professor of Emergency Medicine at the University of Manchester. He is honorary Consultant in Emergency Medicine at Manchester Foundation trust. He is also the Group Director of Research & Innovation at Manchester University NHS Foundation Trust, which is the largest NHS trust in England. His research interests include diagnostics, cardiac disease and the philosophy of emergency medicine. He is an acclaimed international speaker on cardiac diagnostics . He can be found on Twitter as @richardbody

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