Making a determination by a patient is the variability of the symptoms of a heart attack. There are many different symptoms and they are often different for men and women, and young and for old, and for those with certain diseases.
With those cascading complications of any determination, a good rule is that if you are in doubt get medical advice in a hurry or get to a hospital emergency room.
Before discussing the complexities of determining whether the chest pain or other symptom signals a heart attack, it is useful to know that there are many different conditions that can cause chest pain. There’s a useful discussion of some of those different conditions in an article in the newsletter, Bottom Line (December 2009), in an article entitled “Deadly Chest Pain…Your heart may not be to blame.” The article is by Dr. Albert Feinberg, a cardiologist and professor of medicine at the Northwestern University’s Feinberg School of Medicine. Here are some of those non-heart causes of chest pain.
LUNG CONDITIONS. What if you have a sharp pain in either side of the chest, made worse by breathing? That may not be a symptom of a heart attack, but it is still signals serious conditions. Dr. Miller writes, “This may indicate a lung problem such as pneumonia…pleurisy (inflammation of the surface lining of a lung)…or a blood clot that formed elsewhere (usually in a leg vein), broke off and traveled to the lungs. A pulmonary blood clot is life-threatening and requires hospitalization and treatment.”
AORTIS DISSECTION. What if you have excruciating tearing pain in the chest or between the shouldere blades? Dr. Miller writes, “This pain arises from ‘dissection’ of the aorta (the large artery that carries blood from the left ventricle to the rest of the body) and occurs when blood from the aorta burrows between the layers of its wall. This condition is a major emergency requiring immediate medical care.”
Now I’m sure you’ll be happy to be introduced to some less serious chest pains.
ACID REFLUX. Let’s say you have a burning discomfort in the middle of the chest, which may radiate to the throat, and usually occurs after eating spicy food or drinking alcohol or coffee. This may be acid reflux, a condition in which stomach contents get washed up into the esophagus. This is not an emergency, but if it is recurrent it should get treatment.
MUSKULOSKELETAL PROBLEMS. What if you have pain in the chest, shoulder or upper back, which is aggravated by certain movements, such as reaching for a an object or putting an item on a high shelf?
Dr. Miller writes, “These pains are typically due to a musculoskeletal problem such as a strained muscle or tendon or arthritis. Each merits medical attention, but none is a serious health threat.”
You can also have sharp,shooting pains in the chest that last a few seconds. These transitory pains are usually insignificant. But before you get too bold in self-diagnosis note the placement of such words as “usually” and “typically.”
NECK PROBLEMS. Lets say you have pain on the side of the neck and/or across the right or left shoulder, and sometimes in the upper chest on the same side as the affected shoulder.
This may be a symptom of a ruptured spinal disk in the neck. Treatment depends on the severity of the problem.
PANIC ATTACK. What if you have breating problems (such as shortness of breath or hyperventilation), perhaps accompanied by chest discomfort? This should be evaluated by a doctor.
This should also be understood in the context of chest pain that suggests a heart attack. You should also pay attention to severe pain, but you should also know that sometimes mild chest pain can signal a heart attack, and sometimes severe pain may not be a heart attack. It may be the pain of sore muscles.
Dr. Miller offers this general rule: “If you experience any felling in your chest that’s new or that you don’t understand – especially if it persists – consult a doctor.” Here are the typical symptoms of a heart attack, as cataloged by Dr. Miller: “Pressure, squeezing or heaviness behind the breastbone in the center of your chest, often associated with nausea, sweating, light-headedness or shortness of breath.” Note that contrary to some popular impressions, the heart is located in the center of the chest, not the left side.
And this is important information you may be unaware of, according to Dr. Miller. Someone may suffer milder chest pain for up to two weeks before the onset of the severe pain of a heart attack. So Dr. Miller offers this advice: “If you sufer mid-chest pain, call 911 and get to a hospital emergency department as quickly as possible. Do not ait to see if the pain goes away. Prompt treatment will minimize damage to your heart muscle and may save your life.”
There are two other heart problems you should be aware of. One is a medical emergency and the other is not, but requires medical attention.
STABLE AGINA PECTORIS. Dr. Miller describes the typical symptoms of this condition as follows: “A crushing pain or mild to moderate squeezing, tightness or heaviness in the middle of the chest brough on by physical exertion, emotional stress or cold weather – all of which can increase the work of the heart. Pain is relieved by rest and usually lasts five minutes or less.”
This pain of angina pectoris is caused by insufficient blood flow to the heart usually caused by fatty deposits that narrow one or more coronary arteries. Pain is relieved by rest and usually lasts less than five minutes.
This is not a medical emergency but calls for a prompt visit to the doctor.
UNSTABLE ANGINA. Here the symptoms, according to Dr. Miller, are as follows: “Unexplained pain (not necessarily severe) in the middle of the chest, tightness, constriction, squeezing or heaviness…and/or pain in the neck, left should or left arm. These symptoms persist and/or may occur while you’re a rest or awaken you at night.”
This is associated with significally impaired blood vessel flow, and often indicates an impending heart attack. These symptoms require going to a hospital emergency department immediately.
Herb Denenberg is a former Pennsylvania Insurance Commissioner, professor at the Wharton School, and
Pennsylvania Public Utility Commissioner. He is a member of the Institute of Medicine of the National
Academy of Sciences and is a board member of the Center for Safe Medication Use. He is an adjunct
professor of insurance and information science and technology at Cabrini College. You can write Herb
at POB 7301,St. Davids, PA e-mail him at hdenenberg@aol.com or reach him at his two Web sites:
thedenrep_archive.org or denenbergsdump.org