Living Well: All chest-related symptoms should be red flags
From: Roman Bystrianyk (rbystrianyk_at_healthsentinel.com)
Date: 08/16/04
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Date: 16 Aug 2004 09:49:01 -0700
http://www.healthsentinel.com/news.php?event=news_print_list_item&id=126
The study showed heart attack patients who do not have chest pains are
up to three times more likely to die of the illness, probably because
doctors do not recognize their symptoms. An estimated 13 percent of
patients without chest pain died in the hospital, compared to 4.3
percent of patients with chest pain, said researchers at Concord
Hospital in Sydney, Australia. Patients without chest pain tended to
be older women with diabetes, heart failure or high blood pressure.
Patients who suffered chest pain were more likely to be smokers with
clogged arteries. Less common but still potentially deadly heart
attack symptoms include fainting, shortness of breath, excessive
sweating or nausea and vomiting. Any sudden, rapid or unexplained
changes related to these symptoms are considered health red flags.
Bob Condor, "Living Well: All chest-related symptoms should be red
flags", Seattle Post-Intelligencer, August 16, 2004,
Link: http://seattlepi.nwsource.com/health/186236_condor16.html
For more than three years, Donna Tronvig of Maple Valley visited
doctors to determine just what was causing a persistent burning
sensation in her chest. The pain was enough at times to make her stop
for rest between the car and grocery store door.
"I saw a bunch of doctors and all them said I was fine, that nothing
was wrong," said Tronvig, during a work break from her job in the
floral department at a Safeway supermarket in Issaquah.
Tronvig started with a cardiologist. Makes sense. Burning sensation in
the chest. Not the classic squeezing-pressure chest pain but, hey, the
heart's in that region.
The cardiologist put Tronvig through a stress test. She passed with
flying colors.
"I figured I was heart-healthy," recalled Tronvig.
Next she consulted internists and digestive specialists. She saw a
lung specialist. The only diagnosis was severe heartburn. She took
high-strength heartburn medication that did nothing to alleviate the
burning.
On Oct. 8, 2001, Tronvig felt so lousy that her husband, Richard,
refused to go to work that day. Instead he vowed to help his wife "get
to the bottom of this." The Maple Valley couple drove to the emergency
room at the University of Washington Medical Center.
It was Tronvig's fortune that Dr. Larry Dean, director of the UW
Medicine Regional Heart Center, was on call that day. He examined
Tronvig, listened to her story and decided she might be suffering from
cardiovascular disease. Dean looked past the fact that Tronvig was
only 43 and did well on a stress test.
"My litmus test is if someone is sick enough to go to the emergency
room," Dean said, "then I will look at every possibility about why
that person is suffering."
Dean ordered some blood tests and asked Tronvig to stay in the ER's
observation area. The tests prompted him to order an angioplasty
procedure that uses dyes injected in the blood to determine any heart
blockage.
"It was a Thursday," said Tronvig. "The procedure showed significant
blockage. The doctors wouldn't let me go home. I had surgery (triple
bypass) on Monday."
Tronvig doesn't regret the lost weekend. She says she is feeling great
and that six-month checkups with Dean continue to be only good news.
"I got lucky," says Tronvig, a mother of two high-schoolers and one
college student. "I was close to having a heart attack or not being
here at all."
Tronvig said her age and apparent healthy appearance worked against
her. Doctors just looked past heart disease as the cause. A study
published this month in the medical journal Chest adds fuel to
Tronvig's position -- or that of any woman who has encountered
disbelief that a female might be suffering a heart attack or require
cardio attention.
The study showed heart attack patients who do not have chest pains are
up to three times more likely to die of the illness, probably because
doctors do not recognize their symptoms. An estimated 13 percent of
patients without chest pain died in the hospital, compared to 4.3
percent of patients with chest pain, said researchers at Concord
Hospital in Sydney, Australia.
Patients without chest pain tended to be older women with diabetes,
heart failure or high blood pressure. Patients who suffered chest pain
were more likely to be smokers with clogged arteries.
Less common but still potentially deadly heart attack symptoms include
fainting, shortness of breath, excessive sweating or nausea and
vomiting. Any sudden, rapid or unexplained changes related to these
symptoms are considered health red flags, said Dean.
Some of the same symptoms can be attached to a flu bug. Dean's test of
traveling to the ER is a good starting point. If you feel that
terrible and you are willing to tolerate the discomforts of the trip,
you likely are better off erring on the side of caution, going to the
ER and finding out what's happening.
Dean said doctors are learning more about enzymes that leak from the
heart into the blood during cardiac episodes. If a patient tests
positive for these enzymes, such as troponin -- which don't last long
in the bloodstream and sometimes require 12 to 24 hours of ER
observation before appearing -- then he treats the patient as
aggressively as someone with the hammer-squeeze chest pains we all
associate with heart attacks.
The ER observation that Dean mentioned is more likely to occur at
larger medical centers and hospitals. Others might not have the budget
or staff to keep patients under observation.
"One message of this study is people treated less aggressively for
heart disease don't do well," said Dean. "Doctors have a growing
awareness of women's heart disease, but it is important to keep
getting the word out."
Understanding that squeezing chest pain is just one symptom, and less
common among women, is a good start.
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