CHEST PAIN: HEART ATTACK "IS IT THE BIG ONE" OR NON-CARDIAC CAUSE ?

Chest pain is generally considered the second most common cause patients show up at the Emergency Room (ER) doorstep.  Yet only about 20% or less of patients admitted with chest pain to the hospital actually have significant coronary artery disease.   There is a wide spread of how many patients that actually have coronary artery disease which also had other complaints already diagnosed – ranging from about one percent to almost thirty percent.  That’s what makes diagnosing cardiac disease difficult.  Some authors say ER’s discharge 5 % of the chest pain patients that will have a heart attack and another five percent or so that will have a chest pain (or equivalent) unstable episode soon after the discharge.  This problem in diagnosing chest pain, and trying to pick the patients with the “real chest pain” from the heart or cardiac in origin is paramount in the ER.

 

Even with a normal ECG (electrocardiogram) and normal blood tests a condition of serious heart disease can co-exist with the patient.  Many strategy techniques are used to try to capture the potential patient with significant heart disease.  Recently the new CT scanners that can look directly at the heart blood vessels to see potential blockages or narrowings are being used, however not all insurance companies will pay for such studies.

Other causes of chest pain that are not cardiac (heart) in origin are:

gallbladder disease

pneumonia

musculoskeletal disorders

herpes zoster (”shingles”)

anxiety states

peptic ulcer disease

gastroesophageal reflux disease (GERD).

Other more serious diagnoses are:

aortic dissection (a tearing of the aorta itself)

pulmonary embolism (blood clot in lungs)

pneumothorax (popped lung – usually from trauma).

Chest pain can occur in many manners with many masks.  Under the breastbone pain, aching, stabbing, with exercise especially is suspicious.  However, not all cardiac pain has true pain.  Many times pressure, a sense of fullness, shortness of breath can be equivalent to pain in seriousness.  Some patients experience profuse sweating, nausea, light-headedness, and arm, jaw, neck, or back pain.

 With the advancing of age groups, the lack of exercise in children, the growing obesity problem, and the ongoing lack of universal prevention techniques, especially in the United States – chest pain will continue to create diagnostic challenges for patients and their physicians.

Many patients do not live to tell what happened when they started having chest pain.

In 90 percent of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed by fatty buildups. Scarring from a prior heart attack is found in two-thirds of victims. When sudden death occurs in young adults, other heart abnormalities are more likely causes.

About 325,000 people a year die of coronary heart disease without being hospitalized or admitted to an emergency room. That’s about half of all deaths from CHD (coronary heart disease) â€” more than 890 Americans each day. Most of these are sudden deaths caused by cardiac arrest.

 IN DOUBT TALK WITH YOUR DOCTOR IMMEDIATELY OR GO TO AN IMMEDIATE CARE CENTER OR EMERGENCY ROOM !   CALL 911 IF YOU ARE IN DISTRESS OR UNSURE !

FOR MORE INFO CLICK ON THE LINK TO THE AMERICAN HEART ASSOCIATION’S WARNING SIGNS.

http://www.americanheart.org/presenter.jhtml?identifier=3016999

 

 

(adapted:  emergmed-aha with castMD commentary)

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