Health & Fitness

Pain in the chest: When in doubt, see your doctor

James Smith
James Smith Courtesy photo

It was 11:30 in the morning when Janet’s stomach began to feel uneasy. At work, she did not want to attract attention from the other employees, so she sat at her desk, thinking and wishing that the discomfort would go away.

“Are you OK?” inquired one of her coworkers. “You don’t look good.”

Janet began to feel anxious. “I think it’s just a little heartburn … I’m going to take a couple of Tums,” she replied. Her colleague didn’t like the way Janet looked and said, “I think you should go to the doctor. Let me call your husband.”

By the time her husband arrived, Janet was really feeling bad. She was a little sweaty and the indigestion was worse. On the way to the emergency room, Janet began to feel horrible. Now the indigestion was a crushing heaviness in her chest and the pain in her left jaw was unlike anything she had ever experienced before. By the time they were in the ER, she was sweating heavily and felt like she could vomit.

Things happened fast in the ER. An electrocardiogram showed an “acute myocardial infarction” – a heart attack – and blockage in one of her major heart arteries. Treatment was immediately started with IV fluids and medications (morphine for pain relief, nitroglycerin for increasing blood flow and reducing stress on the heart), a chewable aspirin tablet to reduce blood clotting, and blood drawn for lab tests. She was on her way to the cath lab 10 minutes later.

Janet had blockage in one major heart artery, so it was unclogged and a stent was placed in that vessel to keep it open. This heart catheterization procedure also showed that the other heart arteries were clear. The whole intervention took just under 90 minutes to complete. She was transferred to the ICU for close attention and monitoring during her recovery.

Janet felt so much better than she had earlier that morning in the ER. She was very fortunate to have survived this heart attack. Looking back, she should have called 911 so EMS could have diagnosed and treated her more quickly. When she became nauseated during the attack, her heart rate had slowed considerably and she was at risk for serious, even fatal, heart rhythm problems.

Interestingly, Janet did not have the usual risk factors for heart disease. She had never smoked, was not diabetic and was fairly active for her age of 61 years. She was not overweight. Her cholesterol level, although elevated at 210, was mostly “the good kind,” with a very high HDL level of 110. All these things indicated Janet would have been at low risk for a heart attack.

While heart attacks usually occur in people who have smoked, have diabetes, high cholesterol or triglyceride levels, or who are overweight, not everyone fits this profile. A strong family history of heart attacks at a young age or sudden death also indicates increased risk.

Chest pain is something most physicians ask about during an annual physical examination or when a person is seen in the emergency room. As in this case, women often experience heart symptoms that are different from the typical “heaviness” or “pressure” that men complain about when having a heart attack.

Pain in the chest can occur for many reasons, but when accompanied by sweating, nausea and an uneasy feeling of impending doom, it requires immediate attention.

Other causes for chest pain include digestive, lung and muscle and bone problems. Many of these can be serious or life threatening as well, while others may not be.

When in doubt, do not hesitate to call 911, go to the emergency room or see your doctor immediately. It could save your life or that of a friend or loved one.

James Smith practices internal and vascular medicine with Kansas Physician Group.