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Chest Pain? Don't Wait!

Healthline
Why is it that, on a regular basis in the ER, I see very intelligent patients with chest pain that clearly could be a “heart attack” wait at home for hours before they come in to see me? I suppose there must be some degree of denial of their symptoms. “If I ignore the pain and don’t go to the hospital, it can’t be my heart…” On an intellectual level, this clearly doesn’t make sense, but I see it almost every day, and this is too bad, because, with a heart attack or a stroke (a “brain attack” – more on that another day!), “time is tissue”… Every minute wasted before getting to definitive care (either a cardiac catheterization or use of a “clot busting” drug), allows more heart muscle to go starved of oxygen and die. This means a weaker pump and a shorter life expectancy.

So, if you develop chest pain, especially if it feels like a heaviness or pressure sensation, or like an unfamiliar “indigestion” you should seek prompt medical attention. Other worrisome signs that it might be your heart include onset with or shortly after exertion, associated shortness of breath, nausea or sweating, and movement or radiation of the pain into the neck, jaw, back, shoulder or arm (either side).

Steps to take:
  • immediately find a place to rest
  • loosen any constrictive clothing
  • call 911 right away and request an ambulance (they’ll arrive with the equipment needed to begin managing a heart attack, though you still need to get to the hospital for the definitive treatment)
  • take an aspirin (if you’re not allergic to it)… best: chew and swallow 2 baby aspirins
  • try to stay calm… to slow your heart rate and reduce how hard it must pump
I’d be remiss if I didn’t, in closing, throw out those familiar “ounce of prevention” tips – eat healthy, exercise, don’t smoke, keep high blood pressure and/or diabetes under control, and watch your cholesterol.

But, most importantly, if you have worrisome symptoms, don’t wait!... get yourself promptly to the ER!

Stay alert and stay safe.

- Dr. Bob

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17 Comments:

  • At Fri Apr 20, 06:40:00 PM 2007, Blogger Michelle said…

    I've been to the ER twice for pains that you described and was told it is anxiety and now I am having pains around my left breast into my arm pit, shoulder and neck. Do I just assume it's anxiety? I feel stupid everytime I go in and they tell me NOTHING is wrong, but they really don't do any tests where they could see my heart. Heart disease is high in my family, very high. What do I do?

     
  • At Mon Apr 23, 02:11:00 PM 2007, Blogger Robert L. Norris, MD, FACEP said…

    Michelle,

    You don't mention some key issues such as your age, and any other risk factors you might have for coronary artery disease ("atherosclerosis"). Certainly, a strong family history of heart disease is a significant risk factor that should be taken seriously. You also do not mention what diagnostic studies were done in the ER to determine that your symptoms were due to "anxiety."

    It is very true that excessive stress and anxiety can cause patients to have very real, non-life-threatening chest pain (and it's NOT "all in their heads"). We don't really understand very well just why that is, but it happens pretty often.

    Folks who have chest pain that is thought to be anxiety-related should most certainly get a primary care physician (family practitioner or internist) who can orchestrate whatever additional evaluation is necessary to make sure that there is nothing serious going on. This could involve an exercise stress test, a cardiology consultation, and, possibly, even a cardiac catheterization.

    ERs are great places to go for the initial evaluation, but follow-up for most complaints, not just chest pain, is important. The addage that "time will tell" is very true in medicine, and follow-up over time is vital.

    I wish you health and wellness!
    Dr. Bob

     
  • At Tue May 08, 12:36:00 AM 2007, Anonymous Anonymous said…

    Hi Doctor.Bob,
    I have discover my heart was not function very well when I was in Secondary 5 in the year of 2005. At first, I would need to rest longer after my P.E lesson. Normally after P.E lesson, I only needed to rest up to 10mins or so. But since july on 2005, I discovered I needed to rest up to 30mins after my P.E lesson in order for my heart beat to go back to normal.
    Then when I came to polytechinc in the year 2006, I discovered that I would get chest pain very often. Such as I was sitting in the lecture hall and I can feel the pain; when I cried for more then 10mins, I would feel the pain getting stronger; when I was laying on the bed prepare to sleep, I would feel the pain sometimes also without notice. I am very worried about my health now as I have low blood pressure, use to get gastric pain often during my secondary school life. My family don't know that my health was that bad, only my boyfriend knew about my health. I dare not go to visit the doctor as I am very scared to hear the result. He had been with me whenever I am in pain, he knew how to clam me down whenever he discover I am not very right. Should I see doctor to check up what had really happen to my health?

     
  • At Tue May 08, 01:20:00 PM 2007, Blogger Robert L. Norris, MD, FACEP said…

    Dear Anonymous,

    ABSOLUTELY you should seek the counsel of your physician to determine the cause of your symptoms. As the Swedish saying goes: "Worry gives a small thing a big shadow."... go see your doctor and put the worry to rest.

    I wish you well,
    Dr. Bob

     
  • At Fri Jun 08, 06:30:00 PM 2007, Anonymous Brianna said…

    Hey,
    Hey I've been having chest pain since monday. It really hurts like in the middle of my chest. And sometimes it feels like I am about to stop breathing so I have to take deep breath. What is wrong with me.

     
  • At Mon Jun 11, 03:55:00 PM 2007, Blogger Robert L. Norris, MD, FACEP said…

    Brianna,

    I am sorry to hear that you are having pain. I'd suggest that you seek medical advice from your physician or a local Emergency Room right away... as the blog states, "Don't Wait!"

    I wish you well,
    Dr. Bob

     
  • At Sun Jun 24, 04:48:00 PM 2007, Blogger Jenny said…

    Hi Doctor Bob,

    I'm experiencing some pain in the middle of my chest. It hurts especially when I'm taking a deep breath. It's like the pain is in my chest going up to my throat. I felt like there's something in my throat that I need to cough. Would it be chest wall pain? I've been experiencing it for 2 days now and I'm taking ibuprofen. The pain will goes out but it keeps on coming back. What do I need to do.

    Thank you,

    Jenny

     
  • At Mon Jun 25, 06:57:00 AM 2007, Blogger sherryo46@hotmail.com said…

    My name is Sherril. I have been having some pains under my left breast and from my shoulders down to my finger tips. I went to the doctor he told me to make an appointment at the hospital to get an xray on my chest. My appointment is on the 3rd of September. I think that is too long don't you?
    When I walk or exercise I have chest pains.

     
  • At Mon Nov 19, 09:03:00 AM 2007, Blogger Serena said…

    Hello, I have some odd symptoms and am not sure what it is. I sometimes get chest pains. Mabey 1-2 a month. Every now and then I get severe ones though. Completely deabilitating where it hurts to breath let alone move. It starts by my sternum and spreads to my back directly behind it, and often to the sides. The ones that hurt the worst are often proceeded by having trouble breathing (feeling like I'm not getting any air down my windpipe even though It is very obvious I'm breathing). It happened after running once, and the others were after a few hours after I ate. I was sent to an allergen who told me that I was having anaphylactic attacks and gave me low dose antihistamines. Now I will randomly start having trouble getting air through my throat (the antihistamines help a little) regardless of where I'm at, or what I've eaten. And I'm still dealing with the problem of my chest randomly hurting. I'm 18yr old female and I'm begining to get curious as to what is going on.

     
  • At Tue Dec 04, 03:52:00 AM 2007, Anonymous Emily said…

    It started about three in the morning all of a sudden it felt as if something was squeazing my heart. The pain was unbearable I did not tell anyone as I did not want to worry my mom. I figured I'm only 18 so it can't be my heart. Then I could hardly breathe I gad to face my head up to get air down. My fingers became numb my neck felt like it was gonna break any second, and my blood turned cold. Finally I went to my local walk in clinic they wouldn't see me said it was to severe and sent me to the ER. When I got to the ER they took some test and through out the whole time the pain was still unbearable they gave me baby chewables and some painkillers it just made my heart stop racing but it still felt as though something was sitting on my chest or squeazing my heart. What could this have been? The doctor sent me home and said it was oxygen bubbles around the heart. And that it was not serious correct me if I'm wrong I thought anything that had to do with the heart was serious. I still feel pain in my heart the squeazing stopped and so did the racing howwever now my neck is like permanately messed up and there is this pounding throbbing in the back of my head that connects my neck well right above my neck on my lower head it throbs constsntly. My doctor seems to think it is not serious. Could she be wrong?

     
  • At Sun Jan 06, 07:19:00 PM 2008, Anonymous Anonymous said…

    I am fourteen years old and have been experiencing sharp pains in my heart. I can still breathe normally and my heart rate is still fine. This pain comes and goes, sometimes I dont get it for months, but today I've experienced them a lot more than usual. Everytime I get these pains, I have the tendency to burp. Could this be due to gas? Or is it something more serious?

     
  • At Mon Jan 07, 05:44:00 PM 2008, Anonymous Anonymous said…

    I also have been to the ER multiple times with chest pain just to be told it is anxiety. But I did go through a thorough follow up but still cant understand what it is. I am an avid exerciser and I started getting a ripping just to the left of my sternum about where my heart is but the pain started in my back area with pressure only in my chest. Since I have been unable to exercise and find it trouble to work bc the pain comes and goes. The orthopedist said i have no torn muscles so what are the best test to have performed to rule out a tear in my aorta? I know CT is good but is there anything with a better sensitivity and specifity? The pains makes me dizzy and faint. I definitely know some of it is anxiety but even anxiety meds dont take away the pain when it comes on.

     
  • At Wed Jan 09, 02:31:00 AM 2008, Anonymous Ness said…

    im 19yrs old and recently over the past week my chest feels like there is this sharp pain over the right side of the sternum so where your right lung is...and its a sharp stab pain and then the right side of my back hurts...when i breathe there is this cold air/breeze that i feel...Also my chest just feels really tight only on that side- i have asthma but its really mild case...

    Help if u can im worried and as a nursing student i can't pin point much..

     
  • At Fri Jan 11, 03:56:00 PM 2008, Anonymous Anonymous said…

    hi, ive been getting chest pains for a year now am 19years old ive been to the doctors and they said ive pulled a mucsscle i left it as that as the year has gone on ive been getting them more and more about a month a go i was watching tv in bed all of a sudden i got it really bad i was finding it hard to breath it was hurting my legs and my arms went like jelly my boyfriend was worried he called a ambulance when i got to the hospital they couldnt find anything wrong my heart rate was very slightly low am still getting the pains not as bad as that do but the pain goes from my chest round to my back. what is it

     
  • At Sun Mar 30, 11:10:00 AM 2008, Blogger gem said…

    Im sorry but doctors need to stop DIRECTLY assuming 1. Depression and 2. Smoking for ALL ailments no matter what it is.
    I had to go to the ER thinking I was having a heart attack. Episode lasted 2 hours and no tests showed anything except elevated D-dimmer. Went to cardio and he ruled everything out. Meanwhile I live with pain constantly in the sternum area that for no Known reason will radiate up to the chest and or to the back making it feel like a kidney infection and also radiate pain SO excruciating it becomes hard to breath and ribs feel literally broken. Thankfully full blown attacks are not often but I have pain everyday in sternum and kidney area. Sternum feels bruised all the time. Sometimes feels like a balloon is growing inside making pressure on everything. Im tired of going to doctors and blowing my hard earned money on docs who cant take it seriously or me seriously. At this point I wouldnt even be proud of my children if they went into the health care industry. It pisses me off to no end. I know this pain is not right. It is not normal. I will either die not knowing what it is or sunk in the poor house trying to get to the root of the source. What do doctors charge so much for when they NEVER have an answer. Its ALWAYS guessing.

     
  • At Thu Apr 03, 05:09:00 PM 2008, Anonymous Anonymous said…

    Hello there I am James and am 22 I have been experiencing really bad pains in my chest and into the left side of my neck, and at times I feel as though my breathe is being taken away from me. I have been discovered that my blood pressure is radical really high and irreagular. On one occassion it was 175 over 115. I thought I was going to die. Just the other day I went to get checked and found out it was 169 over 110. Again they sent me home. I have pains that make me feel as though I am going to collapse is there anyone whom can help me or give me some advice thanks James

     
  • At Mon May 19, 08:57:00 PM 2008, Blogger chronically ill in Northern CA said…

    Hi Dr. Bob.

    I am 39 years old, female, with a pacemaker. I had the pacemaker implanted March 17th, 2000. I've been told it needs to be replaced this year as my heart is using it more than they expected.

    Lately, I've been having some mild chest pain and trouble breathing. I mean, it's not like gasping for air, but it feels like I need to take deep breaths to get the air I need..

    It sort of feels like a small child on my chest..

    I also have sever pain in the back between the shoulder blades.. I'm tired, nausea, light headed and somewhat a little dizzy and quite irritable.

    I've had 3 mild heart attacks in the past and several TIA's. Not sure if that has anything to do with my current problem.

    Does any of that mean I need to go to the ER by ambulance?

    I have MS too... Does that have any affect on how I am feeling?

     

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