Each year, more than 4 million Americans check themselves into emergency rooms for chest pain. Although most of them suspect they are having a heart attack, nearly 80% of them are not. Other disorders can have symptoms so similar to those of a heart attack, that even emergency room doctors often have a difficult time determining the root of the chest pain.
The most telling sign that you might be having a heart attack is a sensation of severe pressure and discomfort in the center of the chest. According to Dr. Michael Farkouh, the Director of the Chest Pain Unit at Mt. Sinai Hospital, many patients never actually experience any chest pain.
“We may ask a patient often, ‘Are you having chest pain?'” Farkouh says. “And they’ll say, ‘No, but there’s a lot of pressure in my chest, as if an elephant is stepping on my chest or as if my chest is in a vice.'”
Many Sources for Chest Discomfort
Chest discomfort can be caused by a variety of other disorders, though. Farkouh says that for a quarter of those admitted to the emergency room for chest pain who are not having a heart attack suffer from unstable angina–a condition where the heart muscle is starving for oxygen. He says these patients are at a high risk for having heart attack, but are not actually having one.
But the majority of those who incorrectly suspect they are having a heart attack are actually suffering from acid indigestion–severe heartburn. Farkouh says these patients present similarly to those who are having a heart attack. Frequently, it’s only after treating the patient with different medications that doctors can weed out those with indigestion.
“These patients don’t respond to the usual cardiac medicines that we give patients, and they also will have some relief of their pain with an antacid,” Farkouh says. “So classically, in the emergency department or even in doctors’ offices, we have the nitroglycerin on one hand to see if they respond and, on the other hand, we have what’s called the GI cocktail, the gastrointestinal cocktail, where we give patients antacid to see if they respond. And sometimes that tells us.”
Another percentage of patients who think they are having a heart attack are actually suffering from cartilage or muscle problems in their chest. Dr. Farkouh says he can more easily figure this out simply by touching the patient’s chest.
“What I do then is ask the patient, ‘Does this replicate the pain that you suffer… does this make it worse?'” he says. “And if it does–remember the heart is contained within the chest cavity, and it’s very hard to touch the heart directly–so if you have replication of pain on palpation of the ribs and the cartilage… then often you can diagnose… a form of arthritis of that cartilage.”
Other warning signs that may accompany a real heart attack include profuse sweating, a pain radiating from the chest down the left arm, shortness of breath, and stiffness in the neck region.
If you do exhibit some of the symptoms of a heart attack, Farkouh says immediate action is crucial. He advises a different course of action for those with a history of heart problems and those without.
“For the patients with known heart disease, I would follow the recommendations of their doctor, who would probably tell them the parameters by which they should know when to come to the emergency room,” he says. “And I would pin your doctor down as to ‘What are the characteristics of my pain or my symptoms that would make me eligible to come to the emergency room, and when should I call you?'”
For those with no history of heart problems, Farkouh recommends, “If you have chest pain which is in the middle of your chest, which feels like pressure, a sensation of extreme discomfort that you’ve never experienced before, and that is accompanied by… the symptoms that we described… go immediately to an emergency room. It is very important that a patient is treated as aggressively as possible. And for a heart attack, the sooner you’re treated the more likely you are to survive, and the more likely you are to save your heart from any extreme amount of damage.”
Article By: John Roberts, Medical Writer