By Kristin Eckland, Nurse Practioner and feature medical writer; blogs on thoracic surgery at www.cirugiadetorax.org and general surgical information and travel at www.cartagenasurgery.wordpress.com
This is the first in the series on chest pain emergencies. During this series we will talk about recognizing symptoms, where to go, what 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 these indications very seriously and consider them to be cardiac in nature, until proven otherwise. It is critical that people be able to identify the possible signs and symptoms of chest pain emergencies so that they recognize the need to seek emergency medical attention.
Time is the enemy!
I cannot emphasize this enough!! The best way to treat a heart attack is to prevent it, by treating the condition known as acute coronary syndrome (“ACS”) before it leads to a heart attack, or destroys 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 Syndrome versus Heart Attack: What’s the difference?
I often use the following analogy when talking to my patients to explain the difference between ACS and heart attacks, 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. That area, depending on its size and location in the heart, determines whether the patient lives or dies.
What is “chest pain?”
The term, “chest pain” in itself is misleading, as many people, particularly women and diabetics do not experience the symptoms that that are typically depicted during a heart attack (“myocardial infarction”). For this reason, these individuals have a greater likelihood of dying during a heart attack. In fact, several studies show that despite new treatments, and faster interventions, two-thirds of women presenting with a heart attack will die from it. When these people do present for medical assistance, because the symptoms are atypical, it is often several hours or even days after symptoms began.
Often, after visiting a doctor or emergency room, patients feel embarrassed and may minimize symptoms. Do not be embarrassed. You know your body – if you think that this “indigestion” feels different it’s important, so tell us. In fact, we have a special name for these symptoms – we call them “chest pain equivalents.”
The classic symptoms of angina (chest pain) are:
– Pain or pressure in the chest behind the breastbone. It is often describes as “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 when unrelated to recent food consumption, or different from previous experiences.
– Nausea.
– Numbness sensations in chest, arm, face, even the earlobes.
– 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 month that you can no longer do normal activities without becoming short-winded or fatigued, this is a very important symptom.
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. People often tell me, “I thought I was just out of shape,” or “I was just getting old.” Symptoms that develop over a course of weeks, or months, are not normal and are not a normal part of aging.
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 rather than the onset of a digestive problem. If these problems 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.
Better silly than permanently disabled, or dead. Try feeling lucky instead, since that’s what you are. Cardiovascular disease is one of the leading causes of death worldwide, so raising an alarm about chest pain is not silly – ever! If doctors are able to rule out an acute coronary event, they will likely want to schedule you for some additional testing. Just because your symptoms weren’t caused by “the big one” doesn’t mean that you don’t need to be screened for underlying cardiac disease to prevent future cardiac problems.
And if, the tests come back with normal results, it’s an excellent time to treat that indigestion that prompted you to see us in the first place!!
Next time, we will talk about where to go if you are experiencing these symptoms.