Posts Tagged ‘chest pain emergencies’

Originally published on Mexico on my Mind

This is the first in the series on chest pain emergencies.  During this series we will talk about recognizing symptoms, where to go, what to tests or treatments to expect, and what medications you may receive.

Detection of a problem

The development of chest pain or other abnormal sensations in the chest should always be considered a potential medical emergency.   In medicine, we take this extremely seriously and it is considered cardiac in nature, until proven otherwise.  It is critical that people be able to identify the possible signs and symptoms of acute chest pain emergencies so that they are able to recognize the need to seek emergent medical attention.

Time is the enemy

The best way to treat a heart attack is to prevent it, by treating the condition (known as acute coronary syndrome or ACS) before it leads to a heart attack or death of cardiac tissue.  In cardiac conditions, just like with strokes, time is the enemy; as we have only a short window to administer medications and treatments aimed at preserving heart muscle.

Acute Coronary Syndromes versus Heart Attack: What’s the difference?

I often use the following analogy when talking to my patients to explain the difference between ACS, Heart attack and the treatments used for both.  Think of a houseplant you forgot to water before you went on vacation.  Now if your vacation is short, and you return soon enough, the soil may be dry, the leaves may be brittle, but the plant can be saved by watering it.  But if you head off to Europe, and when you return your plant is brown, shriveled and the leaves are crumbles; the plant has died, no amount of water is going to bring it back.  It’s the same with your heart.  If a patient presents early with symptoms caused by a lack of blood flow to the heart muscle, and we restore blood flow, the heart survives with minimal damage.  But if patients come to the hospital after having symptoms for hours or days, the area of the heart affected will be dead.

Now, in actual heart attacks (myocardial infarctions) the size and location of the dead heart tissue,  determines whether the patient lives or dies.  Many people may survive the initial heart attack but may die in the days and months following from heart attack related complications such as congestive heart failure or tachyarrhythmias like ventricular tachycardia/ ventricular fibrillation.

Nurses in the cath lab.  Interventional cardiologists can perform an emergent cath to open blocked arteries

Nurses in the cath lab.  Interventional cardiologists can perform an emergent cath to open blocked arteries and prevent additional heart damage

What is ‘chest pain’?

However, the term, ‘chest pain’ in itself is misleading, as many people, particularly women and diabetics do not experience the symptoms that are typically depicted during a heart attack (or myocardial infarction).

This is called ‘atypical symptoms’, and is one of the reasons that these individuals  have a greater likelihood of dying during a heart attack.  In fact, several studies show that despite new treatments, and faster interventions, 2/3rds of women presenting with a heart attack will die from it.

This may happen because these more subtle symptoms go unrecognized, and this, untreated.  When these people do present for medical assistance it is often several hours or even days after symptoms began.

Often, even after presenting to a doctor or emergency room, patients feel embarrassed, and may minimize symptoms.  Don’t be embarrassed.  You know your body – if you think that this ‘indigestion’ feels different from any ingestion you’ve had in the past – that’s important, so tell us. In fact, we have a special name for these symptoms; we call them ‘chest pain equivalent’.

Now the classic symptoms of angina (chest pain) are:

–          Pain or pressure in the chest behind the breastbone.  People often say it feels like there is ‘a weight on my chest’

–          This sensation may radiate to the arms or jaw

–          Sweating or clammy feeling

–          Weakness or dizziness

But I would like to add to the list, based on the experiences of my patients:

–          “Reflux” or indigestion symptoms, particularly in unrelated to recent food consumption, or changed from previous experiences.

–          Nausea

–          Numbness / tingling/ pressure/ pain sensations in chest, arm, face, even the ear lobes

–          Fatigue (sudden onset)

–          Swelling of the feet (called edema)

–          Shortness-of-breath, which may be worsened by laying down

–          Dyspnea on exertion – if you notice over the previous weeks or a month that you can no longer do normal activities without becoming short-winded or fatigued, this is important.

Now it is important to note, that the vast majority of patients I’ve treated had actually been experiencing symptoms on and off for several months, so let’s clarify indigestion symptoms, and remember, when in doubt – head to the hospital. 

If pizza always gives you indigestion, but you haven’t eaten pizza, or it feels different from the indigestion from pizza, this may be angina or your chest pain equivalent.

“I thought I was just out of shape”

People often tell me, “I thought I was just out of shape,” or “I was just getting old.”  Symptoms that develop over the course of weeks or months are not normal, and are not a normal part of aging.

Example:  If you could walk 2 miles six weeks ago, and now become overwhelmingly fatigued or short-of-breath walking half that distance, this is not normal.  If exercise or exertion causes burning or ‘reflux’ symptoms, this may be ‘atypical angina.’

Timing of symptoms is important

If your symptoms start with activity, i.e. you walk up stairs and start having heartburn symptoms, or your ear goes numb, or you feel nauseated when you go for a walk, this may be a sign that your heart is struggling versus a digestive problem.  If these problems progress, and awaken you from sleep, be very concerned – this is one of the hallmark signs of an impending heart attack and is called, “angina at rest.”

But what if I get to the hospital and it is just heartburn?  Then I will feel silly.

Don’t ever feel silly.  Lucky, maybe, since cardiovascular disease is one of the leading causes of death worldwide, but silly: never.  If doctors are able to rule out an acute coronary event, they will then schedule you for some additional testing.  Just because your symptoms were not caused by “the big one” doesn’t mean that it isn’t a good opportunity to screen for underlying cardiac disease to detect serious cardiac problems such as blockages in the arteries.

Also, if all the tests come back with normal results, it’s an excellent time for us to treat that indigestion that prompted you to see us in the first place, so it’s never a wasted trip.



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