85% of hospital admissions for chest pain are NOT heart attack

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters

“I was asleep and my symptoms woke me up. I had several simultaneous symptoms, but the first one seemed to be central chest pain. It wasn’t sharp or crushing or burning, more like a dull pressure. The pain radiated down my left arm and up into my neck and jaw. I had cold sweats, and I felt nauseated.”

Laura Haywood-Cory, age 41, heart attack, six stents

Researchers tell us that most of us already know that chest pain like Laura’s could be a symptom of what doctors call Acute Myocardial Infarction (AMI – or heart attack) or Acute Coronary Syndrome (any condition brought on by sudden reduced blood flow to the heart muscle).  So it may not surprise you to learn that chest pain is the main reason that over 6 million people rush to the Emergency Departments of North American hospitals each year. These visits also represent a whopping 25% of all hospital admissions – yet 85% of these admissions do NOT turn out to be heart-related at all. 

Admitting people to hospital who don’t need to be admitted not only takes up valuable staffing and hospital resources that could be assigned to real heart patients in need, but also costs the health care system billions of dollars each year.

This is a real dilemma for the medical profession.

So what do you do if you’re working in Emergency medicine? Do you admit every patient complaining of chest pain despite knowing that 85% of the time, the symptom is actually unrelated to the heart?  Or do you come up with an alternative diagnosis and send the patient home – at the risk of failing to diagnose a real heart attack?  See also: What is causing my chest pain?

That latter choice of alternative diagnosis may be behind the alarming tendency of many Emergency physicians to dismiss women’s cardiac symptoms – even in those like me who present with textbook AMI signs (central chest pain, nausea, sweating and pain down my left arm) but “normal” cardiac diagnostic test results. 

Research on cardiac misdiagnoses reported in the New England Journal of Medicine, for example, found that women in their 50s or younger were seven times more likely to be misdiagnosed and sent home from the Emergency Department in mid-heart attack compared to our male counterparts. (1)

The consequences of this were enormous, according to researchers: being misdiagnosed and sent away from the hospital doubled the chances of dying.

Trouble is, we know that at least 10% of women experience no chest pain at all during a heart attack.(2) 

And even standard cardiac diagnostic tests may not be as accurate as we’d like them to be in women.  For example, as reported in the Emergency Medicine Journal, a patient’s initial electrocardiogram (ECG or EKG) in the Emergency Department has a sensitivity of just 20% to 60% in accurately identifying an acute myocardial infarction – so cannot always be relied upon to rule out heart attack.(3) 

And the sensitivity of a single set of blood tests for cardiac enzyme markers at the time of a patient’s presentation to hospital is considered “poor”, according to the American College of Emergency Physicians.(4)

If we’re counting on our health care providers to figure out these tests, we might do well to remember a study published in the Journal of Internal Medicine that asked residents in internal medicine to read the ECGs of suspected heart attack patients. There was disagreement among these doctors about over 70% of the test results.(5)

I sometimes wonder how many people with chest pain had already shown up in my Emergency Department before I arrived on that fateful morning – each of them presenting with frightening symptoms like mine, but who were actually among the majority of people with chest pain that ends up being caused by something other than heart disease. 

I must have seemed to that clearly burned-out, exhausted, disinterested Emerg doc as just another middle-aged woman with indigestion. That was the misdiagnosis he then awarded me before I was sent back home, feeling supremely embarrassed for having made such a fuss over nothing.

Remember that many women experience no chest symptoms during a heart attack.(6)

This means no pain, no pressure, no heaviness, no fullness, no tightness, no aching, no burning or any other symptoms of any kind in any part of the chest area.

Period.

But for those who DO have chest pain, how can patients (and Emergency physicians) tell if that inherently scary symptom might be caused by a brewing heart attack or not?

Dr. Salim Rezaie asked this very question recently, writing for fellow Emergency Medicine colleagues who wonder:

“Are there specific aspects of the patient’s history that can increase or decrease the likelihood that a patient has acute coronary syndrome and/or acute myocardial infarction?“

Dr. Rezaie teaches Emergency Medicine at the University of Texas Health Science Center at San Antonio, and is also the founder of REBEL EM, where he published this review to help Emergency physicians figure out if any given person with chest pain needs to be admitted with a possible cardiac event.

The review is based on five studies that looked at how a patient’s chest pain symptoms correlate with an actual cardiac event (studies recommended by Dr. Amal Mattu on his EMCast podcast of July 2012).*

Here’s Dr. Rezaie’s summary of what the five studies found:

Clinical factors that INCREASE the likelihood of a cardiac cause:
  1. Chest pain radiating bilaterally to both the right and left arms/shoulders
  2. Diaphoresis (sweating) associated with chest pain
  3. Nausea and vomiting associated with chest pain
  4. Pain during exertion

(NOTE: I had every one of these symptoms, yet I was misdiagnosed with acid reflux and sent home from Emergency).

Clinical factors that DECREASE this likelihood include chest pain that is:

  1. Pleuritic (associated with taking deep breaths or coughing)
  2. Positional (made worse by moving the neck or arms)
  3. Sharp, stabbing chest pain
  4. Reproducible with palpation (pressing on it)

But Dr. Rezaie also adds this important warning to colleagues working in the Emergency Departments of the world:

“These were all fantastic articles looking at aspects of the patient’s history in helping aid us in clinical decision-making, but none of these elements alone or in combination can reliably help us rule in or rule out ACS or AMI.”

I’m including the key findings below of these five studies mentioned by Dr. Rezaie, but with one important disclaimer:

These studies (particularly older studies) were not specifically focused on women’s experience with cardiovascular disease. Female patients may or may not have been included in statistically significant numbers in these studies. In the first study mentioned, Edwards’ sample included a hefty 57% female population. But in the Goodacre study, only 38% were women. (Where available, I’ve included gender demographics below).

As I’ve written here, here and here previously – and in the words of New York cardiologist Dr. Nieca Goldberg, author of the book by the same name:

“Women are not just small men.”

When University of Toronto cardiologist Dr. Wendy Tsang reviewed cardiac research published in three prestigious medical journals (The Journal of the American Medical Association, The Lancet, and the New England Journal of Medicine), here’s what she found:

Athough women comprise 53% of all patients with cardiovascular disease, in published cardiac research they represented on average only:

  • 29% of subjects with coronary artery disease
  • 25% with congestive heart disease
  • 34% with cardiac arrhythmia

In fact, despite sweeping National Institutes of Health policy changes in research protocol to correct this under-representation of women in cardiac research, Dr. Tsang says that “under-representation has not drastically changed over the past decade” – a reality she describes as “shocking”.

So with that specific grain of salt, and for your general information, here are the five studies on cardiac symptoms that Dr. Rezaie evaluated:

1. Edwards et al, 2011

The objective of this study on over 3,300 people (57% women) presenting to Emergency with chest pain was to see if severe chest pain is linked with a greater likelihood of heart attack. Severe chest pain here was defined as 9–10 on a pain scale of 0 to 10.

Bottom Line:  Severity of pain is NOT related to likelihood of AMI either at initial presentation to Emergency, or composite end points (death, revascularization, or AMI) within 30 days.(7)

2. Body et al, 2009

The objective here was to assess individual symptoms when predicting a diagnosis of AMI or the occurrence of adverse events within six months (796 patients were studied; number of women: unknown). The strongest positive predictor was sweating (diaphoresis) with chest pain. Other positive predictors were:
  • Nausea and vomiting with chest pain
  • Chest pain radiating to both shoulders, right shoulder, or left shoulder
  • Central chest pain

Symptoms that did NOT strongly predict AMI were:

  • Pain located in the left anterior chest
  • Chest pain described as pain being “the same as previous heart attack”
  • Presence of chest pain while at rest

Bottom Line:  Many “atypical” symptoms are more likely to render a cardiac diagnosis than traditional “typical” symptoms.(8)

3. Swap and Nagurney, 2005

These researchers wanted to identify the specific elements of chest pain that might be most helpful to physicians in identifying Acute Coronary Syndrome (ACS) by searching medical literature published from 1970 to 2005 (number of women: unknown). They reported that the chest pain most likely to mean heart attack was:

  • pain radiating to both shoulders and arms
  • pain radiating to the right shoulder
  • pain that comes on with exertion
  • pain accompanied by sweating

Chest pain less likely to mean heart attack was:

  • pain that’s described as “sharp” or “stabbing”
  • pleuritic pain (pain that’s worse with deep breaths or coughing)
  • positional pain (for example, pain that’s worse if you move your neck or arms)
  • pain that can be reproduced by palpation (pressing on it)

Bottom Line:  No characteristics of chest pain alone, or in combination, identify a group of patients that can be safely discharged home without further diagnostic testing. Also beware the chest pain which radiates to the RIGHT shoulder.(9)

4. Goodacre et al, 2002

This study of 893 patients (38% women) looked specifically at patients who were clinically stable and had a non-diagnostic EKG (an electrocardiogram that did not clearly show any cardiac event had occurred).  Researchers found that even among these patients, symptoms that were most predictive of cardiac cause were chest pain on exertion and pain radiating to both arms and/or the right arm.  Symptoms that were less predictive were presence of chest wall tenderness, nausea, vomiting or sweating (diaphoresis).

Bottom Line:  Clinical features have a limited role in triage decision-making.(10)

5. Panju et al, 1998

This 1998 study is what Dr. Rezaie describes as “an oldie but a goodie”. The authors looked at which clinical features might increase or decrease the probability of heart attack. They reviewed medical literature on the subject published between 1980-1991.  They found that the clinical features that increased the probability of a heart attack diagnosis were chest pain that radiates to both arms, and chest pain that radiates to the right shoulder.  Clinical features that decreased heart attack probability were pleuritic chest pain, chest pain that’s sharp or stabbing, positional chest pain, or chest pain that can be reproduced by palpation (pressing on it).
 
Bottom Line:  A patient’s symptom history alone can help, but can NOT rule out ACS/AMI!(11)
 
Finally, Dr. Rezaie also reminds us of a compelling reason for “over-triage” (admitting patients who don’t have cardiac problems – just in case):

“The single greatest contributor to financial losses in malpractice claims against emergency physicians comes from failure to accurately diagnose acute myocardial infarction.”

*© 2014 Salim Rezaie R.E.B.E.L. EM
(1) Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000; 342:1163-1170.
(2) 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.
(3) Speake D, Terry P. Best evidence topic report: first ECG in chest pain. Emerg Med J. 2001; 18:61–2
(4) American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina. Ann Emerg Med. 2000; 35:521–44.
(5) Gjorup T et al. Interpretation of the electrocardiogram in suspected myocardial infarction: a randomized controlled study of the effect of a training programme to reduce interobserver variation. J Intern Med. 1992; 231:407-412
(6) Canto JG, Rogers WJ, Goldberg RJ, et al. Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality. JAMA. 2012;307(8):813-822.
(7) Edwards et al. 2011. Relationship between pain severity and outcomes in patients presenting with potential acute coronary syndromes. Annals of emergency medicine, no. 6 (July 29). doi:10.1016/j.annemergmed.2011.05.036.
(8) Body, Richard, Simon Carley, Christopher Wibberley, Garry McDowell, Jamie Ferguson, and Kevin Mackway-Jones. 2009. The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes. Resuscitation, no. 3 (December 29). doi:10.1016/j.resuscitation.2009.11.014.
(9) Swap, Clifford J, and John T Nagurney. 2005. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA, no. 20 (23).
(10) Goodacre, Steve, Tom Locker, Francis Morris, and Stephen Campbell. 2002. How useful are clinical features in the diagnosis of acute, undifferentiated chest pain? Academic Emergency Medicine : official journal of the Society for Academic Emergency Medicine, no. 3. 
(11) Panju, A A, B R Hemmelgarn, G H Guyatt, and D L Simel. 1998. The rational clinical examination. Is this patient having a myocardial infarction? JAMA, no. 14 ( 14). 

♥

  Q:  Have you sought emergency care for chest pain that turned out NOT to be heart-related?

NOTE FROM CAROLYN:  My book “A Woman’s Guide to Living with Heart Disease“ reads like the“Best Of” Heart Sisters blog archives.  You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (if you use their code HTWN , you can save 30% off the list price).

See also:

What is causing my chest pain?

The freakish nature of cardiac pain

Misdiagnosed: women’s coronary microvascular and spasm pain

Words matter when we describe our heart attack symptoms

The chest pain of angina comes in four flavours

“You’ve done the right thing by coming here today”

Check out my patient-friendly, non-jargon glossary of over 200 words, phrases and terminology you’ll hear about cardiology

Read more on how specialized Women’s Heart Clinics cover a broad range of gender-specific cardiac conditions experienced by women, as described in this report,  Focused Cardiovascular Care for Women

Published by Carolyn Thomas

31 thoughts on “85% of hospital admissions for chest pain are NOT heart attack”

  1. Pingback: Dr. Nicole Cain, ND, MA
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  3. I am 3o years old and having chest pain since 2 months; ECG, X-Ray and blood tests all results appear negative; doctor told me it’s just muscular pain but still I’m not satisfied. please suggestions, what can I do??

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  4. From Greece.

    Hi Carolyn Thomas,
    Please, can cold cause chest pain? At my house I have no heater to keep it warm, and since three days now the kind of pain that I feel is too much and it happens to me only in the night. Can cold cause this chest pain?

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    1. Hello Anih,
      I’m not a physician so cannot answer specific medical questions but I can tell you generally that some patients who have heart disease complain of worst chest symptoms during cold weather. Try wrapping a warm scarf around your nose and mouth before you go to bed (to warm the air that you take in). See a doctor if you can. Good luck to you…

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  5. I had a heart attack at 38 in 2010; I’m 43 now. I have 5 stents. When I was having a heart attack, my vitals were normal. They took blood and that is how they knew. I do think if someone walks into an ER room complaining of chest pain, it should be taken seriously. I had a recent incident: I was having chest pain again – they did an EKG and said nothing wrong go home – I ended up back in hospital diagnosed with heart attack.

    Liked by 1 person

    1. Flora, I’m so glad you didn’t stay at home after you were sent home, but returned to that ER. This is particularly disturbing given that you had already survived one heart attack in 2010! Chest pain should always be taken seriously by ER staff, but especially chest pain in a person who’s already a heart patient! Best of luck to you…

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  6. I have been having symptoms for 3days now… i get pains on my shoulder then it travels down to my arms and at times my legs too. I have dizziness, nausea, chest pain/ pressure in the middle of my chest feel numbness in my jaw etc. I went to the ER did blood work they came back normal they did an ekg it came back normal but i am still having these symptoms… what should i do?! They told me that it could be an anxiety attack but thus keeps happening out of know where i feel like i am going to have a heart attack!

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    1. Carmen, I’m not a physician so cannot offer any opinion on your specific case. I can tell you that, as this article suggests, the vast majority of hospital admissions for chest pain turn out not to be heart-related at all. Right now you have no idea if this has anything to do with your heart, but It’s possible it IS anxiety in which case please see your family physician. Meanwhile, read this:
      Good luck…

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  7. oh goodness gracious went to ER it hurt to breathe deeply, I wish I read this article earlier I would have known that “pleuritic pain” is not indicative of a heart attack. Gotta say was pretty bad chest pain, but irregardless twas quite embarrassing after all was said and done.

    Liked by 1 person

    1. Hi Patty – it’s always better to be safe than sorry whenever you have “bad chest pain” – even if it turns out to be non-cardiac. The good news: your symptoms do not appear to be heart-related!

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  8. Thank you so much for this post. I went to the ER early yesterday morning after reading several articles on women’s heart attack symptoms. After having tingling in my hands and arms while driving the last hundred or so miles of a long car trip, I got home hoping it was just from the position my arms had been in for driving so long. I was also feeling nauseous. When I lay down, I started feeling tightness in my back then my chest, and the tingling in my arms wasn’t going away.

    I started to worry and began Googling for heart attack symptoms in women to refresh my memory. I saw that I was having several but still spent a while struggling with the “am I overreacting?” feelings.

    Then, I started to feel a tingly, burning tightness in my chest, and I reluctantly told my husband I thought I needed him to drive me to the ER.

    We got our two daughters (4 and 7) out of bed and went to the ER. At this point, I was scared (my dad died of a heart attack when he was 54), and I was also plagued with guilt. My long car trip had been my own choice, and I had drunk too much Red Bull to make sure I stayed awake on the drive, which had me returning home around 2 a.m. So I sat in the ER answering questions while also telling myself the whole thing was all my own fault, worrying about the school day I wouldn’t be able to prep properly for a sub, and still not sure if I’d made the right call by going to the hospital.

    The nurses were very caring and helpful. They did the EKG, and I waited for the doctor. A med student came in to ask questions then went to relay my story to the dr. The chest and hand tingling were coming and going. Each time I was left alone with my thoughts, I was slammed by guilt, fear, and doubt. I was nearing 24 hours awake, which obviously contributed to my emotional state, and I tried to control the tears and avoid a full meltdown.

    When the doctor came in, he summarized my symptoms back to me, but he got the order wrong, saying I had the chest pain followed by the tingling arms. I corrected him, but he continued on, asking why I was upset. That pretty much shattered my hold on the emotional wreck I was trying to avoid, and the guilt and fear collided in a mess of sobs as I explained the various factors contributing to my tears. I tried to control them as I explained them, which led to some hyperventilating.

    He then explained to me that the EKG was fine and he believed the chest pain I was experiencing was caused by indigestion and the tingling in my hands and arms was from lack of oxygen caused by hyperventilating. He said he was going to give me some Ativan to help me calm down and a GI cocktail for the indigestion.

    His explanation made no sense to me. I’ve had plenty of heartburn in my life thanks to grad school and pregnancies. This was not the same pain. Nothing like it. As for his explanation of my hand/arm tingling, I had not hyperventilated until talking to him — at least an hour after that had started. It just doesn’t seem or feel like a plausible explanation. At the time, I went with it. I was utterly exhausted and the EKG was normal — I clung to the fact for reassurance, even though it didn’t feel right.

    Now I’m left with this uneasy feeling. How do I decide whether to seek treatment if I have those symptoms again? (Obviously, I’m never touching Red Bull or other energy drinks again.) I’m envious of the commenter whose doctor told her she’d done the right thing. I had no such reassurance, and I’m still feeling a lot of guilt for dragging my family to the ER for “nothing,” while at the same time still feeling like it WASN’T nothing.

    Your post has helped assuage some of that guilt, so thank you. At this point, I am thinking I will make an appointment with my regular doctor to discuss the event with her and get her opinion on how I should move forward. The ER doctor’s diagnosis simply does not ring true with what I experienced, and I have spent much of my time since then thinking that perhaps it is treatment like this that is the real reason women are more likely to ignore their heart attack symptoms (rather than those other reasons posed by all the articles I read prior to going in to the ER).

    Once again, thank you for this post.

    Liked by 1 person

    1. Good plan to see your own doctor. Right now, you simply don’t know if your symptoms were heart-related or not (and Red Bull has been linked to cardiac issues) – but you need to find out. Do not let the dismissive attitude of that Emerg doc (asking why you were so upset, for example) stop you from seeking further help, especially if symptoms return. Bottom line: you KNOW your own body. You know when something is just not right. Best of luck to you…

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  9. Reblogged this on The Skeptical Cardiologist and commented:

    “The skeptical cardiologist notes that today has been proclaimed “Go Red For Women” day. I’m not sure what wearing red on the second Friday of each February accomplishes but I do think it is important that women recognize that they are at risk for heart disease and stroke.

    “The AHA sponsored http://www.goredforwomen.org site proclaims: ‘Each year, 1 in 3 women die of heart disease and stroke.’

    “That is pretty alarming! After three years of this, there will be very few women left.

    “A much better source of information than the AHA or Go Red Ror Women sites in my opinion is the blog of Carolyn Thomas entitled Heart Sisters.

    “Carolyn suffered a heart attack and her site is a wealth of information on women and heart disease. Her posts are well researched and informative.
    She recently wrote about the fact that 85% of hospital admissions for chest pain are not for Heart Attack.

    “With her permission, I am reblogging this important post which reviews the symptoms of heart attack that differ between men and women and the misdiagnosis of heart attack that is more common in women.”

    Liked by 1 person

  10. My first symptom was tightness in my THROAT. Eventually, I started having stomach pain and pain on the entire left side of my face (not the jaw), as well as slight nausea. After surgery, my symptoms have been nausea, stomach pain, and mild perspiration.

    Liz Lockhart ~ quadruple bypass surgery and subsequent heart attack

    Liked by 1 person

    1. Liz, with such a broad range of atypical cardiac symptoms, you are very fortunate to have been correctly diagnosed. Many women are not so lucky and are repeatedly sent home from the ER. Throat/neck symptoms are often reported by women as initial heart attack signs, but pain in the entire left side of your face is a new one for me. Thanks for sharing this.

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  11. Excellent summary of this problem!

    As a cardiologist, I get phone calls daily from patients with chest discomfort or other symptoms that could represent a heart attack and I have to sort out just by their history whether they should immediately go to the ER or whether I can see them in the hospital.

    It helps to know the patient’s past medical history and the characteristics of the discomfort mentioned in the review article are definitely useful but we always err on the side of being overly cautious because missing even one episode of acute heart attack could mean the loss of life.

    When patients ask me how they can tell whether the chest/arm/jaw discomfort they are experiencing is from their heart there is no easy/simple/short answer. Acid reflux pain, for example, is common, triggers nerve receptors similar to the heart and is virtually indistinguishable from cardiac pain.

    This article would provide an excellent summary of the problem for my patients and with your permission I would like to reblog it with my own comments.

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    1. Hello Dr. Anthony – coincidentally, I was just leaving a comment on your site while you were sending this one in to me today! If I found Dr. Rezaie’s review of these studies helpful, I’m sure your own patients would as well. Yes, of course, you may reblog this for your readers.
      regards,
      C.

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  12. I will always keep going to the ER for any chest pains that do not subside with Nitro or an Anxiolytic (Xanax). I have panic attacks that have the same symptoms as an AMI, takes me about 20 minutes to figure out what I am experiencing. After 20 minutes, I carry on or go to the hospital. Twice it’s been a good thing I went. Twice it was still a good choice, but they were not emergent cardiac events. 50% emergent vs 50% non-emergent, all cardiac related. Love my ER staff and the care they provide, even when they send me home with just a recommendation to follow up with my Cardiology Team.

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      1. From Drugs.com: “The dose may be repeated approximately every 5 minutes until relief is obtained. If the pain persists after a total of 3 tablets in a 15-minute period, or if the pain is different than is typically experienced, prompt medical attention is recommended.”

        I take a Xanax immediately before the first Nitro, time the Nitro doses if needed. If I am still having chest pain after the third dose, I head for the ER. As it’s not a panic attack, Xanax works for me in 15 minutes.* I make sure I let them know what I have taken. Last visit was the beginning of diagnosing Angina.

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        1. Thanks for this, Elizabeth. Just to confirm, did you mean to say “If it’s a panic attack” in that third last sentence?* Lots more here from cardiologist Dr. Bernard Lown on taking nitro.

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          1. I mean, if it’s a panic attack, the chest pains will go away long before I take the third dose of Nitro. For me, a Panic Attack feels the same as a cardiac event (AMI). * If the Xanax works, it’s a panic attack. If it doesn’t work, I’m having a cardiac event. The need for a third Nitro will send me to the ER.

            Now that is really confusing…

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  13. Twelve years ago this month I walked into an Emergency room in Omaha (Clarkson West -UNMC) and said I had chest pain – clutching my chest and sweating. They literally dropped everything, gave me aspirin and nitro and set up an IV. The EKG was not normal and they sent me to be admitted to the hospital. The next day I had bypass surgery with a mammary artery graft. I had the widowmaker ( “and it works both ways” to quote my cardiologist.) I credit the quick action of the emergency room staff for saving my life.

    Of course I kept saying maybe it’s indigestion. Since then whenever I go to the ER with chest pain I am treated like I am having another heart attack. I am grateful for their care and concern. Their job is to save lives, not to worry about the bottom line.

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    1. You raise such an important point, Chris – the very common experience of assessing every episode of chest pain (after you’ve already survived a major cardiac event) as being another heart attack (it’s that “level of uncertainty” as described by Nicola’s nurse – see comment below). Asking oneself: “Is this something? Is it nothing? Should I call 911?”) is both frightening and exhausting.

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  14. I will be forever grateful to the ER nurse who came to remove the canula in my arm and discharge me after I experienced chest pain a month after having a SCAD (Spontaneous Coronary Artery Dissection).

    While I was feeling like I had wasted their valuable time she said in the gentlest of tone and with great compassion: “After this event, you may have a level of uncertainty about your heart for the rest of your life” and went on to reassure me that going to hospital was exactly the right thing to do and they would all much rather treat someone and discharge them confident that it wasn’t a heart related event than have them rolled in on a stretcher too late to help.

    Great article as always.

    Liked by 1 person

    1. Nicola, I wonder if that kind nurse knows what a profoundly important gift she gave you that day. Dr. Jonathon Tomlinson of the U.K. wrote a similar message about the importance of doctors telling worried patients: “You’ve done the right thing by coming here today.”

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  15. On the night of my MI (having had about half a dozen previous unstable episodes of burning central chest pain), I woke up with the burning chest pain but this time it would not go away. Then my tongue and throat felt constricted, then I got the squeezing sensations and pressure and weight on the center of my chest, twinges in my L shoulder, neck, chest and arm. Then I went numb from both shoulders to elbows. The EMTs arrived about 20 minutes after they were called, I had normal blood pressure and heart rate and 2 negative EKGs in my bedroom. Thankfully they urged me to come to the ER despite my symptoms subsiding. I was given 325mg of ASA in the ambulance. At no time was there sweating, nausea or vomiting or feelings of doom. I had 2 STAT stents, and 3 more 2 weeks later as symptoms were not resolved.

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    1. Your paramedics were brilliant, Lauren – urging you to go with them to the ER despite those subsiding symptoms and “normal” diagnostic tests was exactly the correct protocol! Hope you’re doing much better now.

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