Chest pain could be deadly; do not delay treatmentSunday, April 11, 2021
Dr Ernest Madu Dr Paul Edwards
IN our column this week we have decided to shed light on a potentially catastrophic complaint that is often treated with levity in Jamaica.
Chest pain due to heart vessel blockage can cost you your life if you ignore it. Patients experiencing a heart attack may present with chest pain associated with shortness of breath, profuse sweating, nausea and vomiting. The pain may feel like persistent heaviness or can be described by patients as “an elephant sitting on my chest”. Individuals may find it difficult to get comfort or relief and, in some cases, may feel like their life is slipping away. Such discomfort may be described as impending doom. When a heart attack presents this dramatically, there is an urgency and people tend to seek immediate medical attention.
The biggest misses happen when the presentation is not this dramatic. Chest pain may still be ominous but deceptively so. Many patients with heart attack do not present in a dramatic fashion. For many, the pain is not really pain in the classic sense. It is oft described as a dull ache in the chest, a feeling of discomfort or more confusing for the unwary; a feeling of stomach upset that may be accompanied by nausea that may be mistaken for 'gas'.
In Jamaica many individuals with heart attacks ascribe their feelings to gas and resort to tea or ginger with the erroneous belief that they can belch it away. Tea and ginger have misled many individuals, causing delays in seeking treatment and an inevitable catastrophic outcome.
If you have chest discomfort, no matter how mild, please seek immediate medical attention. No amount of chest patting or back thumping will make a heart attack go away. The pain may ease along with “easing your body” but it is likely lying in the lurch waiting to return. If you read just one thing from our article today, it is that chest pain can and will kill. Delays in treatment can be very costly in money and in life but early intervention saves lives.
There are many causes of chest pain but until you know the cause of your specific chest pain, please do not assume that it is benign. You should seek immediate medical attention if you develop sudden chest pain — especially if it is severe, heavy, pressing, tight or lasts longer than 15 minutes and is associated with breathlessness, nausea, or vomiting.
Are you at risk for a heart attack?
Traditionally, cardiologists have focused on individuals with risk factors as most likely to have a heart attack, and hence, much of the publicity surrounds the risk factors for heart attack. These risk factors include age greater than 55, hypertension, diabetes, high cholesterol, smoking, sedentary lifestyle, obesity, and family history. While it is true that individuals with multiple risk factors are at an increased risk for a heart attack, what is also true is that most individuals presenting with their first heart attack do not have multiple risk factors at the time of presentation. What this means is that you can have a heart attack even if you believe you do not have the risk factors for it.
It is therefore safe to assume that you are at risk for a heart attack even if your risk is lower than your friend's. Now that you know that you are also at risk for a heart attack, what will you do if you develop sudden symptoms? It is important to have a plan in your head before an emergency requires you to act.
When to get help for chest pain
Chest pain can be caused by many things, including minor muscle aches to frank heart attack or tear of a major blood vessel. It is often impossible for the layperson to differentiate between dangerous and benign forms of chest pain. Simply “sounding the chest” cannot rule out an obstruction of a vessel, and even for the cardiologist or heart specialist, it can be challenging to make such differentiation without the benefit of diagnostic testing. It bears stating that no chest pain should ever be dismissed without evaluation.
It goes without saying that not every chest pain is due to a heart problem so why then do we emphasise evaluation for heart condition for individuals with chest pain? Simply put, the only types of chest pain that can kill may kill you very quickly without intervention. These are related to chest pain resulting from obstruction of blood flow to the heart muscle (leading to heart attack and complications including cardiac arrest), chest pain resulting from tear of major blood vessel (aortic dissection) or chest pain resulting from massive blood clot to the blood vessels to the lungs (pulmonary embolism or PE). What they all have in common is that there is an embarrassment to heart function or circulation.
Unfortunately, the presentation is not always very clear and so individuals may ignore the complaint or waste valuable time trying various ineffective home remedies, such as the ubiquitous ginger tea, for none-xistent gas. Do not do that. Seek immediate medical attention.
Where do you go for medical evaluation of chest pain?
Now that we have established that neither home remedy nor tea is an effective solution for chest pain, it is important that you are purposeful in your actions while seeking medical evaluation for chest pain. Every chest pain must be treated as a medical emergency until the cause is established. If it is established to be heart- or vascular-related chest pain then the sense of urgency is further escalated. Why? Because we know that time is critical when chest pain has to do with the heart or major vessels. Delays lead to death or severe disability while speedy response saves lives and prevents major complications. It is important therefore that you seek medical attention for chest pain at a facility where there is the expertise and infrastructure to deal with chest pain and most importantly where there is a sense of urgency in dealing with chest pain.
In one of our previous columns we discussed the concept of a “waiting list” as an inappropriate concept for heart disease patients. Waiting is not acceptable when heart attack is a possibility. Response must be quick, decisive and efficient.
Heart attacks are becoming more prevalent in Jamaica than previously thought and this may be related to changing lifestyles and an increase in the risk factors that promote heart disease. While we do not have definitive statistics, we estimate that nearly 7,500 Jamaicans have heart attacks each year.
Dr Trevor Ferguson and his colleagues reported in 2010 that about 12,000 Jamaicans were living with heart attacks. Sadly, many of these individuals do not get adequate care because of the lack of urgency, expertise or preparedness at many local facilities in dealing with chest pain and heart-related conditions.
Patients with chest pain need immediate attention. In individuals with chest pain due to heart attack there is a strong correlation between the time to intervention and risk of death. Even a few minutes' delay could be deadly or result in major complications.
A heart attack occurs when a fat or cholesterol plaque ruptures in a heart vessel and abruptly shuts off blood circulation to the heart muscle. This interruption of blood flow results in damage to the heart muscle, leading to chest pain. The most effective way to deal with this is to perform an emergency procedure to see the blocked arteries (angiogram) followed quickly with a procedure to open the blocked artery (angioplasty and stent placement), or sometimes open-heart surgery. A heart attack can quickly lead to death or major complications if appropriate treatment is delayed or denied. It is important therefore that individuals evaluate all possible medical facilities within their locations to determine those facilities with the appropriate equipment, sense of urgency, skill sets and track record.
Common heart attack signs and symptoms include:
· Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back, sometimes associated with cold sweat
· Shortness of breath
· Lightheadedness or dizziness
· Nausea, indigestion, heartburn, or abdominal discomfort.
If you or someone you know is experiencing any of these symptoms, you must seek immediate medical attention — but be sure to go to a place with the ability to deal with a possible heart attack in order to avoid delays in treatment. Speed saves lives. Delays cause death.
Knowing where to go and why to go before you need to go may save your life.
We will continue our discussion on heart disease next week with an in-depth look at cardiac arrest and sudden cardiac death, which are catastrophic consequences of heart attacks and other underlying heart conditions.
Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC, are consultant cardiologists at Heart Institute of the Caribbean (HIC) and HIC Heart Hospital.
Dr Madu is a main TED Speaker whose TED talk has been translated into 19 languages, seen, and shared by more than 500,000 viewers. He has received the Distinguished Cardiologist Award, the highest award from the American College of Cardiology and has been named among the 100 most influential people in healthcare and among the 30 most influential in Public Health. Dr Madu is also a recipient of the Global Health Champion Award from the University of Pennsylvania. He is past CEO of HIC and is currently the Chairman of IHS Holdings Ltd, an asset management company with interests in the USA, Africa, and the Caribbean.
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