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HEART Insight:
doi: 10.1097/
Features: Related Risk

Chest Pain Means You're Having A Heart Attack — Except When It Doesn't

MacReady, Norra

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When To Call 9-1-1, And Why You Shouldn't Try To Talk Yourself Out Of It

Chest pain is often a classic symptom of a heart attack, or its milder relative, angina — but it is also associated with several other maladies, from heartburn to pneumonia. If you have risk factors for, or a history of, heart disease, you may fear that every twinge in your chest is the sign of a heart attack. If don't have any risk factors for a heart attack, you may attribute the chest pain to anything but a heart attack and unnecessarily delay treatment that can save your heart muscle, if not your life.

In general, chest pain associated with a heart attack feels like a crushing sensation beneath the breast bone, and is often accompanied by nausea, vomiting, sweating, lightheadedness, and an unexplained feeling of dread, says cardiologist Elliott Antman, M.D., Senior Physician at Brigham & Women's Hospital, Boston. The pain may radiate down the left side of the chest and left arm — or it may radiate down the right arm, or confine itself to the chest, neck, or jaw. Noncardiac chest pain usually is milder and seldom spreads elsewhere.

If you're having a heart attack, the longer you wait to call an ambulance the more damage can occur to your heart. Unfortunately, people often do hesitate, usually for the same reasons:

If it's a heart attack, the longer you wait to call 9-1-1 the more damage can occur

* ▪ It's not really that serious. “If there's no heart attack, great. That's the best thing that could happen,” says Christopher Granger, M.D., Professor of Medicine at Duke University Medical Center in Durham, NC. “But if [it is] a heart attack, then frequently we can save lives through prompt treatment.”

* ▪ People at the hospital will be annoyed if it's a false alarm. “We would prefer to have a false alarm rather than delays,” reassures Antman. “If healthcare providers could choose between patients coming [to the ER] thinking they're having a heart attack but they're not, versus patients who are having a heart attack and are delaying [treatment by] denying it, [the medical system prefers] the former.”

* ▪ What will the neighbors think when the ambulance pulls up at my house? I'll be so embarrassed! “People are afraid that a neighbor or someone at church will notice the ambulance and ask if everything is OK, and they just don't want to deal with those discussions,” Antman notes. He stresses that momentary embarrassment is a small price for possibly saving a life.

* ▪ I'll just pop some nitroglycerin. Not good enough, Granger admonishes. “We used to [advise taking] a nitroglycerin tablet every five minutes, for a total of three nitroglycerins, before calling an ambulance. Now we [tell heart patients] ‘call 9-1-1 if the discomfort continues for more than five minutes,’ because if it is a heart attack, we don't want to lose 15 minutes of valuable time [and have] unnecessary heart damage.”

* ▪ My husband/wife/son/daughter can drive me to the hospital. That also could cost valuable time, says Antman. While you're in the ambulance, the paramedics can monitor your vital signs; start IV lines; administer oxygen, morphine, nitroglycerin, or aspirin; and call ahead to alert an ER team to greet the ambulance and whisk you into a treatment room right away. And should you go into cardiac arrest en route, the paramedics can manage that, too. The ambulance can also zoom through traffic if need be, which a car can't do.

* ▪ My spouse will be angry if I call an ambulance. “Take the initiative to call 9-1-1 urges Granger, adding that a person seldom holds it against you when you save his or her life.

If you have angina or one or more heart attack risk factors — for instance, you're a smoker, have diabetes, are packing 20 or more extra pounds or have been diagnosed with coronary artery disease — Antman recommends that you monitor your symptoms for five minutes and if they don't resolve or get worse, immediately call 9-1-1. As he likes to tell his patients, “time is muscle.”

© 2010 American Heart Association, Inc.