“Doc, is my chest pain an impending heart attack ?”

Myths & facts related to pain related to heart attack
-- Dr Akshay Mehta

Myth No. 1. The chest pain of heart attack always occurs in the left side of chest.
Fact : The chest pain of heart attack can occur in the center of the chest, the left side or the right side. In fact it can occur anywhere from the level of our ears down to the navel. That means it can occur in the jaws, neck, throat, back, shoulders, arms and upper abdomen besides the chest. It occurs in different places in different people.

Myth no. 2. The chest pain due to heart attack is severe, piercing and comes suddenly- like a bolt from the blue.
Fact: Most heart attacks start as mild discomfort in the center of the chest (over an
area, the size of your palm) or on either side or both sides of the chest that increases
in a few minutes, and continues for more than 15 to 20 minutes, or that goes away
in few minutes and comes back again. Most commonly it feels like uncomfortable
pressure, squeezing, fullness or tightness. Sometimes it is a feeling of “gas”, lump,
indigestion or burning in chest like “acidity”. The feeling is different in different
people.

Myth No. 3. Pain in the right arm is not due to heart attack, only left arm pain is important.
Fact : As mentioned earlier, pain or discomfort can occur anywhere in or around the chest, or in either arm or shoulder. Discomfort occurs at different places in different people.

Myth No. 4 Women have the same symptoms of heart attack as men.
Fact : Women are more likely than men to have “atypical” or “non classical” symptoms like nausea, vomiting, fatigue, “gas”, “indigestion”, neck pain, shortness of breath, upper abdominal or back or jaw pain etc. instead of the classical pain described above. This can be misleading and can cause delay in taking prompt action. Hence, heart attack in women is more likely to be missed or diagnosed late.

Myth no. 5. Chest pain due to heart attack always occurs with severe sweating and vomiting.
Fact : Although many heart attacks occur with shortness of breath, breaking out in a cold sweat, nausea or lightheadedness, not all heart attacks are associated with these signs.

Myth no. 6. The pulse rate and blood pressure (BP) during heart attack are always abnormal.
Fact : Although some heart attacks are associated low or high BP , fast or slow heart (pulse) rates, in many heart attacks the heart rate and BP are normal.


Myth no. 7. Burning in the center of the chest is always due to acidity.
Fact : In some people, heart attack pain causes burning in chest similar to “acidity”, and it may be difficult to distinguish between the two. However if the “heart burn” or “acidity” occurs early morning without food or in the middle of night waking up the person from sleep, or if it radiates to back or arms or increases on exertion, it is very likely due to heart disease.

Myth no. 8.: A heart attack never gives a prior warning.
Fact : Many heart attacks are preceded by transient chest discomfort lasting few
minutes called angina (see below) few hours or days before the heart attack. Prompt
recognition and proper treatment of this warning signal could have avoided the heart
attack

Myth No 9 Constant or recurring sharp piercing pain like poking of pins and needles could be due to angina- a warning signal of heart disease.
Fact : Angina is transient chest discomfort due to coronary heart disease and lasts few minutes. It consists of discomfort or heaviness/tightness in center of chest or on either side that is provoked by exertion or emotional stress and relieved by rest and/or nitroglycerin. Sharp, poking pain over a localized (finger tip sized) area, especially just under the left nipple area, which continues for hours or days is not angina disease and is usually due to anxiety..

Myth No 10 When there is discomfort in chest likely to be a heart attack, one should call home a doctor to take an ECG.
No. Minutes matter! One can’t waste more than a few minutes if the pain is even ‘suspected’ to be due to a heart attack. Calling a well equipped cardiac ambulance is the fastest way to get lifesaving treatment if needed. If the ambulance can’t come home in a few minutes, it is best to reach the nearest ICCU where an ECG can be taken and prompt diagnosis made and treatment started. One can be taken in a car, taxi or even an autorickshaw. Remember, reaching hospital within minutes or an hour of chest pain and receiving clot dissolving drugs or emergency balloon angioplasty may mean the difference between life and death and may mean saving the heart muscle from extensive damage.

Cutting delays after a heart attack

Cutting time, saving (heart) muscle ! saving life !!

Most of the time ‘wasted’ before reaching hospital is due to non or mis recognition of heart attack symptoms and reluctance to act fast.

Recognition: How to know it’s coming?

Few heart attacks are sudden and intense — the "Hollywood or Bollywood heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

Chest discomfort : Most heart attacks involve discomfort in the center of the chest (over an area of the size of your palm) or on either side or both sides of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like ncomfortable pressure, squeezing, fullness or pain. Sometimes it is a feeling of “gas”, lump, indigestion or burning in chest like “acidity”. The feeling is different in different people.
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort.
Other signs may include breaking out in a cold sweat, nausea or lightheadedness
As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.
Quite a few times, a similar but milder and shorter lasting ‘warning’ discomfort may have occurred few hours or days before the main ‘event’.
The usual reactions to the symptoms are :
· It can’t be me !
· Let’s wait & watch.
· Why disturb others ? (especially if it’s in the middle of the night).
· The discomfort is mild, it can’t be a heart attack.
· We’ll go in the morning.
· Let’s wait for the family doctor or a cardiologist to come home.

NO. Minutes matter! Even if you're not sure it's a heart attack, have it checked out (phone a doctor about your symptoms). Calling a well equipped cardiac ambulance is almost always the fastest way to get lifesaving treatment. Emergency medical services (EMS) staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. Sometimes, clot dissolving drugs may be given in the ambulance itself which can be highly successful in reducing the damage to heart muscle.
EMS staff are also trained to revive someone whose heart has stopped.
However, if you can't access the cardiac ambulance or it will take time to come, have someone drive you to the hospital right away. If you're the one having symptoms, don't drive yourself, unless you have absolutely no other option. Take a taxi or even an auto rickshaw to the hospital.
Remember, reaching hospital within 1 hour of chest pain and then receiving clot dissolving drugs or emergency angioplasty may mean the difference between life and death or the difference between damage to a large area of heart muscle and minimal or no damage to the heart muscle despite the heart attack.
Finally, please have a health insurance. Unfortunately, many times, it is lacking in people (like the economically disadvantaged) who require it the most .