Aches and mistakes: Is it your heart or your lunch?

Not everyone with chest pain needs to go to the emergency room, but they need to seek medical attention.
"Oh, this is the biggest one I ever had," Fred Sanford would say, clutching his chest with tragicomic flair.

Good thing the old Sanford & Son sitcom did not feature an ER with a chest-pain unit. Fred would've had even more trouble fooling his son Lamont with a fake heart attack.

But people who've had real chest pain know it's not that easy to play it for laughs.

With heart disease the No. 1 killer of both men and women, it's possible that chest pain signals a serious, even fatal, problem with your heart.

Then again, it's possible the pain is just those enchiladas you had for supper.

What to do?

That depends, but there's one thing you should not do if there is any chance your pain might be heart-related.

"Don't drive yourself to the hospital," said Tony Derrick, a nurse and director of emergency services at McLeod Regional Medical Center in Florence.

"Call EMS, or you could end up killing yourself or someone else."

What can cause chest pain?

Heart trouble, of course, is one of the main things that must be considered when a person has chest pain.

About 1.1 million Americans have heart attacks every year, according to the National Institutes of Health. About 40 percent of those people die within an hour of noticing symptoms, before they even get to a hospital. Early symptoms may be followed by fibrillation -- erratic heart rhythms that can be fatal -- and that explains why Derrick doesn't want you driving yourself to the emergency room.

For those who do make it to the hospital, "Time is muscle," Derrick said. That is, the faster you get medical attention, the lower your chance of suffering muscle damage that will incapacitate your heart or kill you.

Heart-attack patients who receive care in a hospital with a chest-pain unit are 37 percent less likely to die, according to a study published in Circulation in 2004.

Dr. Thomas Cook, emergency physician at Palmetto Health Richland, said its 10-bed chest-pain unit lets people get hours of cardiac testing without having to be admitted to the hospital.

Lucy Boulware of Columbia was lying in one of those beds Monday afternoon. A nagging pain she at first thought was indigestion had turned into a more severe, pinching pain that radiated down her left arm.

"They got me right back here and started working on me," said Boulware, 62, who was going to be monitored in the unit overnight.

Tests in the chest-pain unit -- such as electrocardiograms and blood-enzyme tests -- can tell whether a patient needs a procedure such as angioplasty to clear blocked arteries. And they help rule out other ailments that cause chest pain, such as panic attacks.

A severe anxiety or panic attack can cause symptoms amazingly similar to those of a heart attack, including pain, shortness of breath and sweating.

"You don't want to err on the side of saying it's a panic attack when it isn't," Cook said.

In fact, he and other experts said, many noncardiac conditions can cause chest pain -- some potentially serious, some not. These include:

  • Indigestion, or reflux disease.
  • Muscular soreness, perhaps from sports or yard work.
  • Lung ailments such as pneumonia, pleurisy or asthma, collapsed lung or pulmonary embolism (a blood clot lodged in a lung artery).
  • Diseases of the stomach, gallbladder, esophagus or pancreas.

Dr. Greg San, a cardiologist affiliated with the Greenville Hospital System, once saw a patient with terrible chest pain that defied diagnosis for two days. Then, skin blisters appeared: The patient had shingles, an often-excruciating skin condition caused by the same virus that causes chicken pox.

Understanding risks

"Not everyone with chest pain needs to go to the emergency room, but they need to seek medical attention," San said. Mild chest pain that typically occurs after a big meal of spicy food might require a call to the family doctor, rather than a trip to the hospital, he said.

But it's important for people to understand their risk factors for heart disease and take them seriously, San said. "A middle-aged, smoking, hypertensive diabetic has a much higher risk of developing coronary disease and heart attacks than a 30-year-old mountain biker," he said.

Vivian Hatten of Columbia had frequent chest pains for about three months, along with some nausea and sweating. She thought it was heartburn, and started taking a lot of antacids.

"I was self-diagnosing," said Hatten, 51. "I was walking three miles a day, I was drinking water; I thought I was doing pretty well."

Since women's heart pain often can be more of a burning discomfort than a crushing pain, they may be more prone to think it's just indigestion, said Dr. Marian Taylor, a cardiologist with the Medical University of South Carolina in Charleston.

Too often, she said, women tend to delay coming to the emergency room. "Therefore, when they are diagnosed (with heart disease), it may be that more damage has been done, especially if they have risk factors," Taylor said.

Also, she said, new research in female patients shows that "smaller" heart attacks are more likely to cause chest discomfort than in male patients -- another reason not to delay that trip to the doctor.

Hatten had a high-stress job and a family history of heart trouble -- both significant risk factors. Her mother died of congestive heart failure at age 38.

One night last July, her pain got much worse. "I was sweating like crazy," she said. "It felt like someone was sitting on my chest, literally. Oh, my God, the pain."

A friend drove her to Palmetto Health Baptist, and shortly an ambulance took her to Richland, where she had quadruple-bypass surgery.

Besides high stress and family history, significant risk factors for heart trouble include smoking, diabetes, high blood pressure, obesity, high cholesterol and a sedentary lifestyle.

Also: age. "If you are the average 25- or 30-year-old, your risk of having cardiac disease is relatively low," Cook said.

Eddie Collins, 57, had a false-alarm trip to the emergency room 10 years ago. What he thought was a heart attack turned out to be heartburn. So when his chest started hurting last June, he decided simply to take a day off from his job with the National Guard. Uppermost in his mind was avoiding the hassle and expense of an unnecessary trip to the hospital.

But when the pain developed into nausea and heavy sweating, "I added up all the symptoms," said Collins, who lives in Florence. "That's when I got scared and I called EMS."

After a heart attack in the chest-pain unit at McLeod, Collins was whisked to the catheterization lab, where a cardiologist cleared a blocked artery and placed a stent in it to prop it open. The whole process took less than an hour.

Collins said he's glad he didn't wait for the "indigestion" to go away this time.

"I'd be dead," he said.


Contact Linda Lamb at 803-771-8454 or llamb@thestate.com.

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