The puzzle of chest pain

A pain that started in the middle of your chest, just an ache at first, but getting sharper and radiating down your arm. Is it your heartŠ or is it something else? This is the time you don't want to take chances, no matter how foolish you may feel when you leave the emergency room with orders to rest and take Mylanta.

I remember my years as a rookie in the ER. Anxious to get in on all the action, I would frequently be relegated to the job as gofer, or told to manage the treatment rooms -- the child with the fever in room three, or the broken arm in room two when an individual presented with chest pain. The savvy ER nurse (eventually I would include myself in that crew) could see a ''coronary'' in the making within 1-2 minutes and three or four questions. I learned it was something about the patient's color, the way they carried themselves, the beads of sweat on their forehead in spite of the cool temp outside. Many of them never really did complain of chest pain, but rather pain in the jaw, teeth, or wrist, with a little nausea thrown in. Those were the ones you worried about! At that point you cut with the questions, called your co-worker and the ER doc, and the technology of the modern ER would rain down on the ''chest pain'' in trauma room 3.

Now, if you get the feeling there is no exact set of symptoms, age range, sex, body size or shape for determining whose chest pain is related to their heart, and whose isn't, that's good. Let the doctor decide. The families of the DOAs (dead on arrival) had a much harder time dealing then those that had a live but cantankerous family member to take home! Coronary artery disease leading to a myocardial infarction -- an MI or heart attack -- is a class four emergency and is still a leading cause of fatality in men and women here in the U.S.

What are some of the other symptoms related to serious heart-related chest pain? The patient may suffer from any or all of the following symptoms as well: sweating, shortness of breath, pain radiating to the arm, wrist, neck or jaw, or chest pain that worsens with exertion or when breathing cold air, nausea or vomiting, extreme weakness that worsens with exertion, dizziness, rapid or irregular pulse, or feelings of panic and anxiety.

Are there other risk factors involved that may lead to heart attack? If you are a smoker, seriously overweight, suffer from diabetes, high blood pressure, high cholesterol, are genetically predisposed to coronary artery disease, have an inactive life style or high stress levels you should be under medical care, and check in with your doctor if you are experiencing symptoms of chest pain.

But what about all those other times you or a loved one has experienced some sort of chest pain and the doctor says it's not your heart, what is it? According to the experts at the Cleveland Clinic, overexertion and emotional stress can also cause pain or tightness in the chest. It can be a symptom of panic disorder where the heart races or pounds, you feel sweaty and nauseous and short of breath.

Or, you could be suffering with some form of esophageal spasm, hiatal hernia, a gall bladder attack or an inflammation of the rib cartilage common in some chronic degenerative diseases such as fibromyalgia and some kinds of arthritis. There are medical as well as some natural therapies for handling most of these conditions.

Can't I treat my chest pain myself? NO, absolutely not -- not if you like your life and want to go on living it. There are indeed some good herbs, supplements and vitamins along with an improved low-fat and lower calorie diet that can help add life to your years following a coronary insult. But let's not get the cart in front of the horse.

The ER would always be a busy place this time of year -- older people shoveling drives, or not so old guys pushing stalled cars while inhaling all that cold air. It was always a sad thing to see someone so unsuspecting fall victim to a heart attack and maybe die. It's even worse for the families they would leave behind. No big snows yet this year, but the winter is young. If you're seeing yourself between the lines here, go for help. There is lots of life left, even after coronary artery disease!

Till next time, Rebecca.

Uploaded to The Zephyr Online January 11, 2000

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