Part 1 of a 3-part series about pain
I was thinking about the freakish nature of pain the other day. I think about pain quite a bit, actually, given the frequency with which I now experience the ongoing symptoms of Coronary Microvascular Disease. But in 2008, when the first alarming warning signs of a heart attack struck out of the blue while I was out for a brisk pre-breakfast walk, the reality was not at all what I would have ever imagined a heart attack to feel like. And because I was clueless, I believed the Emergency Department physician who misdiagnosed me with acid reflux and sent me home that same morning.
Besides, I’d always figured that any person having a heart attack would clutch dramatically at his chest (in my mind, this person was always a middle-aged man) before crashing down onto the floor, utterly unconscious. (I did not know then that this scenario is NOT a heart attack, by the way; it’s called sudden cardiac arrest, and yes, in well over two-thirds of cases, it does happen to men).
But on that day six years ago, I was fully conscious and able to walk and talk and think throughout my visit to Emergency. Thus my mistaken assumption was to agree with the Emergency doc that I was not having a heart attack after all – despite presenting with textbook symptoms like central chest pain, nausea, sweating and pain radiating down my left arm.
My cardiac symptoms later returned (of course they did!) and increased over time until finally, unable to stand them any longer, I returned to the same Emergency Department. This time, I was greeted by a different doctor plus a new and correct diagnosis of myocardial infarction (heart attack) caused by a 95% blocked left anterior descending coronary artery.
And if you’re having a heart attack, distressing warning symptoms can actually be felt anywhere between nose and navel. When your heart muscle cells begin to run out of oxygen because of a blocked artery or a spasm preventing oxygenated blood from feeding that muscle, they begin to send off signals of pain throughout the nervous system. But your brain may also confuse those nerve signals with signals coming from the arm (or the jaw, shoulder, elbow, neck or upper back) because of the nerve proximity. That’s what referred pain is. It happens when pain is located away from or adjacent to the specific organ involved – such as in a person’s jaw or arm, but not necessarily in the chest.
As I wrote here, a heart attack may cause a sensation of pain to travel from your heart to your spinal cord, where many nerves merge onto the same nerve pathway. So your arm may be perfectly fine, but your brain thinks that part of the heart’s pain is in the arm (or the jaw or the shoulder or the elbow or the neck or the upper back) calling out for help.
This is more common when heart attack occurs in older people or those who live with diabetes. But even using the words “chest pain” to describe this heart attack symptom might be tricky. Many women describe their cardiac chest symptoms not as “pain” at all, but instead use words like pressure, ache, heavy, suffocating, full, tight or burning. See also: Downplaying symptoms: just pretend it’s NOT a heart attack
And remember that at least 10% of women having a heart attack experience no chest symptoms at all.(1) None. Nothing. Zip. Zero. Nada.
What I’ve learned during my own cardiac adventure was this:
There’s pain, and then there’s pain.
Pain in general is actually nature’s way to protect our bodies. Pain has a way of attracting our focused attention in a laser-like fashion, warning us that something might be very wrong. For heart patients, there’s the initial scary pain of a cardiac event, and there can also be ongoing pain following that event. If you’ve had one or more stents implanted, you may experience what we call “stretch pain“ for a while. Although it’s common for heart patients to experience some residual pain following a cardiac intervention, such symptoms may also indicate a serious complication – so call your doctor if pain persists or gets worse instead of better over time.
Since my heart attack, I’ve had lots of time to consider the amazing mind-body relationship of pain. Because of ongoing and debilitating cardiac symptoms (and accompanying daily pain symptoms that feel virtually identical in intensity to my initial heart attack pain), I now see a pain specialist regularly at our Regional Pain Clinic (visits I’ve written about here, and will write about again when I cover the subject of pain self-management in the second part of this 3-part series on cardiac pain).
If you’re living with the ongoing pain of angina, by the way, please ask your physician for a referral to your local Pain Clinic if your community has such a resource.
The physicians, nurses, physiotherapists, occupational therapists and psychologists who work there are true experts in the nature of what pain is and how our bodies interpret that pain. These folks know their stuff. Most other pain patients I see there are living with some type of chronic pain caused for example by arthritis, migraines, injuries, surgical complications, etc.
And where I live, all of my visits/treatments in the Pain Clinic (as well as all cardiology follow-up tests, hospital stays, and doctors’ appointments) are free. Thank you Canada, a.k.a. commie-pinko land of socialized medicine.
My particular kind of ongoing chest pain is generally tolerable most days as long as I pay careful attention to:
- medications (remember, heart sisters, that “Nitro is your friend!“)
- regular daily exercise (as Kentucky cardiologist Dr. John Mandrola likes to say: “You only have to exercise on the days you plan to eat!”
- the portable TENS unit I wear clipped to my belt from dawn to dusk
- keeping a strictly cautious eye on my daily stress levels
- ongoing care from our Regional Pain Clinic staff, an expert pain specialist, and the pain self-management programs offered there.
Meanwhile, here’s my best advice if you or somebody you care about experiences what feels like heart attack symptoms:
- Call 911. Do not let anybody drive you to Emergency. Do not drive yourself.
- While you’re waiting for the ambulance to arrive, chew one regular full-strength (300-500 mg) uncoated aspirin (or generic ASA) washed down with water – provided that you are not allergic or already taking bloodthinning meds.
(1) S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart 2009;95:1 20–26.
Q: Have you ever had an example of freakish pain?
NOTE FROM CAROLYN: I wrote much more about identifying cardiac symptoms in Chapter 1 of my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your nearest library or local bookshop or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 20% off the list price).
Part 2 of this 3-part series: Brain Freeze, Heart Disease and Pain Self-Management
Part 3 of this 3-part series: Chest pain While Running Uphill