The following post is by Dr. John Maguire, co-owner of Simplicity Urgent Care.
Chest pain is one of the most common complaints we see in the emergency departments that I manage here in Northern Virginia. Typically, the patient looks up at me with big, scared eyes and asks, “Am I having a heart attack?”
I always wish that it were easier to tell, but despite medical advances, we are often unable to answer the question during the initial visit.
- Chest pain is a very difficult symptom to pin a diagnosis to because it can be a sign of several other problems, including a broken rib, a blood clot, pneumonia, or a tear in the aorta, among other conditions.
- That’s why most physicians make a diagnosis based on the patient’s medical history. For instance, we know that if the patient smokes, has high cholesterol, and has a family history of heart disease, he or she is more likely to have a heart problem than a healthy triathlete.
- Physicians are trained to create a differential diagnosis, which is a list of the possibilities that could be the cause of the symptoms. With chest pain as the presenting complaint, our first concern is ruling out something that is life threatening before making a diagnosis.
Women and diabetics
There are two groups of patients that will commonly have unusual symptoms when they are actually having a heart attack:
Heart disease is a big threat to women’s health. Believe it or not, statistics show that about 267,000 women die of heart attacks each year — six times more than those who die of breast cancer.
The reason it’s such a big threat is that women who are having a heart attack often have atypical complaints, such as shortness of breath, nausea and / or vomiting, and back or jaw pain. They also experience flu-like symptoms, fatigue, extreme weakness, light-headedness, and cold sweats.
In addition, heart attacks tend to occur in women about 10 years later than they occur for men. About 82 percent of female heart attack patients are 55 or older. They also tend to have high blood pressure, high cholesterol, and/or diabetes (see more on that below). And they are likely to be smokers, overweight, and lead a sedentary lifestyle.
Unfortunately, women are often less likely than men to believe they’re having a heart attack, so they delay seeking emergency treatment. Obviously, this is a lethal combination and one that needs to be paid more attention to. Women with the risk factors listed above need to be diligent about chest pain and seek treatment immediately.
Another group of patients that have atypical complaints when they are having a heart attack is diabetics. In fact, if I had a nickel for every diabetic patient who is having a heart attack with no chest pain, but is complaining of significant nausea, I’d sure have a big pile of nickels.
That’s why physicians must be masters of pattern recognition, and be able to see outside the “normal” patterns to minimize the possibility of missing the tough case.
Signs of a heart attack
Chest pain that is related to a heart attack or other serious heart problem is very often associated with one or more of the following:
- Pressure, fullness, or tightness in your chest
- Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and arms, especially your left arm
- Pain that lasts more than a few minutes, goes away and comes back, or varies in intensity
- Shortness of breath, sweating, dizziness, or nausea
Chest pain that isn’t related to a heart problem is more often associated with:
- A burning sensation behind your breastbone (sternum)
- A sour taste or a sensation of food re-entering your mouth
- Trouble swallowing
- Pain that gets better or worse when you change your body position
- Pain that intensifies when you breathe deeply or cough
- Tenderness when you push on your chest
If you think you are having a heart attack:
- Call 911 and the EMTs will take you to the nearest emergency department. While urgent care centers are great for a lot of things, the emergency department is where you want to be if you are having a heart attack. Please do not drive yourself to the hospital, unless you have no other choice, as your condition could worsen and you risk putting yourself and other drivers in danger.
- Once at the ER or urgent care center, explain the problem and expect to be seen immediately.
- In most cases, an EKG will be done quickly. This recording of the electrical activity in your heart is the first screen for heart attack. It also identifies patients that need to have other heart-related procedures done, including an angioplasty, where the clogged blood vessel is opened with a balloon.
- Unfortunately, a relatively small percentage of patients have EKG changes when they are having a heart attack or angina. So an EKG is not always helpful. That’s why doctors will also ask to draw blood to look for cardiac enzymes, which makes it easier to quickly identify the problem.
Questions? Don’t hesitate to contact me at firstname.lastname@example.org.