By Dr. W. Gifford Jones
April 24, 1988
How do you know when you're having a heart attack? Or a bad bout of indigestion? There's never been a time when it's been more important to know. Several weeks ago I discussed how TPA , the new human Drano, dissolves blood clots in the heart's drain pipes. But to be effective the drug must be injected within the first two hours of an attack.
This presents a major problem for patients. They don't want to stay in bed if rushing to the hospital will save their lives. But neither patients nor physicians want emergency units at hospitals overrun with people who erroneously believe they're having a heart attack when it's due to other less serious conditions. Regrettably there are no clear-cut indications that cry out "heart attack." But there are guidelines that can be helpful to medical consumers.
"Location , location, location" is the motto for success in many business enterprises. It's also helpful to remember in diagnosing cardiac pain. The discomfort of cardiac blockage normally occurs in the middle or power part of the breastbone and may radiate to the jaw or the left shoulder. Pain in the upper abdomen ,however, can be misleading. But if shortness of breath, palpitation of the heart and a sudden feeling of weakness are also present a heart attack should always be considered.
Dr. David Andres, a specialist in emergency medicine in the U.S., has seen thousands of patients with chest pain. He says," cardiac pain is rarely described as sharp, needle-like, piercing, stabbing or knife-like. Rather it often presents as an aching, dull, crushing, squeezing or pressure sensation."
Whether or not to get out of bed is also contingent on how long the discomfort lasts. It's wise insurance to get to the hospital if the pain continues unabated for more than a few minutes. Angina comes on with exercise and normally subsides in 5 to 10 minutes after the stressful activity ceases. The pain of myocardial infarction may come on for no obvious reason and lasts 30 minutes or longer.
A study of 100 patients admitted to the Emergency Departments with chest pain revealed that only 51 were suffering from coronary disease. The rest had a variety of troubles such as gallstones, stomach ulcer, inflammation of the pancreas, muscular pain due to trauma , or merely gas in the large bowel.
A variety of structures in the chest wall and the chest cavity can cause pain. Some troubles such as a ruptured aortic aneurysm or a clot in the pulmonary artery can trigger sudden death. But other non-cardiac conditions are rarely associated with the threat of sudden death.
If you develop sudden pain in the chest try first to jog your memory a bit. Remember that muscle strain or injury to the ribs may not result in pain until several days after the accident. If for instance , you had a few martinis at a party did you forget the hug that fractured the rib? Or is the chest pain the result of forceful coughing , laughter or sneezing? Tenderness over a fractured rib and pain on breathing help to pinpoint this diagnosis.
Pleurisy,an inflammation of the inside lining of the chest cavity, also causes pain on breathing. It can result from trauma, infection or a blood clot in the pulmonary vessels. Similarly pericarditis,inflammation of the sac that surrounds the heart, causes a steady pain that is increased by breathing. And if you've been to your favourite restaurant for an evening of spicy food you may have a simple case of gastritis. But the diagnosis is not always easy to separate from cardiac pain.
Tietze's syndrome is a localized swelling of a single costochrondal junction, the point where the ribs attach to the sternum. It usually causes a constant aching sensation, but sharp pains can be present. The diagnosis is made by pushing on the costochrondal junction which triggers the pain.
Few have heard of Texidor's twinge but nearly everyone has experienced the pain. This sudden discomfort in the left chest occurs while the patient is sitting . It's eased by shallow breathing and a change in position. Texidor's twinge is believed to be due to a transient pinching of the pleura lining the chest wall or the heart's pericardium and lasts for only a few moments.
Patients with chest pain should always consult a doctor if there's any doubt it's due to serious disease. I would also recommend Dr. David Andres book, "Chest Pain, Is it Your Heart" published by Colco Publishing , P.O.Box 35099, Houston, Texas, U.S.A. 77235-5099 for those people who want to know more about this diagnosis.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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