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Wake-Up Call


Lisa Marie Rubin
Formulary Management
VA Western New York Healthcare System;
Clyde Freeman Herreid
Department of Biological Sciences
University at Buffalo


The main character of this case is Denise, who we first meet in the early morning hours as she wakes up in a cold sweat, gasping for breath. But it is her husband, Jeremy, who has been diagnosed with heart disease, not her. What’s going on? In this interrupted case study, in which the other main character is Denise’s heart (who we get to know through a series of “interior” monologues), students learn about the risk factors, symptoms, and consequences of a heart attack. The case is suitable for a course in pathophysiology, first year nursing, enzymology, advanced biology or anatomy, or nutrition.


  • Outline blood circulation within the heart and label a given diagram.
  • Identify the three major coronary arteries.
  • Discuss the pathophysiology of a heart attack, including plaque formation, the role of cholesterol, HDLs vs. LDLs, the blood-clotting and inflammatory systems, and serum enzyme inflation.
  • Differentiate between cardiac arrest, heart attack, ischemia, cardiogenic shock, and arrhythmia.
  • Know the specific enzyme elevation patterns associated with heart attack.
  • Understand why unstable plaque is a greater risk factor for heart attack than stable plaque.
  • Identify key symptoms of heart attack for men and women.
  • Understand a key hormonal difference that may account for why men are more prone to heart disease.
  • Identify possible complications of a heart attack.
  • Identify and discuss critical heart disease risk factors, both hereditary and environmental.
  • Understand key preventative measures to stay heart healthy.
  • Evaluate risk factors based on different patient’s profiles and determine what each person should do to decrease their risk for a heart attack.


Cardiovascular disease; heart disease; coronary artery disease; cardiac arrest; heart attack; myocardial infarction; angina; ischemia, cardiogenic shock; arrhythmia; unstable plaque; HDL; LDL; cholesterol; embolism; heart healthy diet

Topical Areas


Educational Level

Undergraduate upper division, Graduate, Professional (degree program), General public & informal education



Type / Methods




Subject Headings

Anatomy  |   Physiology  |   Nursing  |   Nutrition  |   Biology (General)  |   Medicine (General)  |  

Date Posted


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Teresa Anziano
Healthcare Support Program
Hamilton-Wentworth School District
Hamilton, Ontario L8N 3L1 Canada
Excellent case study! The dialogue format engages the reader and makes learning more interesting. I followed the notes to the teacher and inserted mini review lessons on the anatomy of the heart and circulatory system, which enhanced the students' understanding of the case. I used unlabelled diagrams, which we labeled together as a class. I involved the students throughout by having them go up to the white board and write definitions/answers to questions. I really liked how it shed light on the differences between men and women with respect to their symptoms of heart disease.

Donna Brunelli
Biological Sciences
Allegany College of Maryland
Somerset, PA
I used this case study in my A&P class after we finished reviewing cardiology. The students enjoyed it. I assigned them the task of creating an information brochure as suggested in the assignment section of the case study. I received some very creative and professional-looking pamphlets.

Merle S. Bruno
Professor of Biology
Hampshire College
Amherst, MA
I used the case, "Wake-Up Call," in a class called "Topics in Women’s Health" and it was a real shocker for the students, who all pretty much decided the main character was having panic attacks, an anxiety disorder, or menopause symptoms. Heart "problems" was one of their hypotheses, but not a strong one until near the end. I adapted the case to fit the format I use in class, so I didn’t use it exactly the same way, with the heart as a character. I liked that idea, but it didn’t fit the way we’d been working. It was a terrific case and the students were very challenged and learned a lot. They asked me if this was based on a real person or if it was constructed to make particular points. I didn’t know the answer to that. I found (as I find with any case I use) that I had to make up some family history and life style answers to respond to students’ questions. It’s a little like writing a soap opera, but kind of fun. Thanks to the case authors and the Center for this case, as it formed a big part of my class this spring.