The most frightening cardiac symptom

by Carolyn Thomas    ♥    @HeartSisters

The chest pain. The shortness of breath. The freakish pressure radiating up to the jaw or down the arm. All of these can be signs of a heart attack or other cardiac events..  But for Martie, a 46-year old heart patient diagnosed with Spontaneous Coronary Artery Dissection (SCAD), her worst symptom was described like this:

“The most prominent symptom I had, which kept getting stronger and would not go away, was the little voice in my head telling me this was NOT normal. It is my one piece of advice to all my friends. Listen to that voice in your head!”              .

Countless women reading my blog or sitting in my Heart-Smart Women presentation audiences have over the years echoed Martie’s description of what cardiac researchers call a sense of impending doom.  (I too experienced this awful symptom before my own heart attack – unfortunately, I was halfway through a 5-hour flight from Ottawa to Vancouver at the time).

This feeling of dread may in fact be what Harvard cardiac researcher Dr. Catherine Kreatsoulas calls the “symptomatic tipping point” – meaning, the symptom that convinces women to seek emergency help during a cardiac event.

This conviction is extremely important because we know (from many research studies –  and likely from our own personal experience as well) that women are significantly more likely to delay seeking urgent medical treatment compared to our male counterparts – paradoxically, even when we’re suffering obvious cardiac symptoms.

We also know that women tend to minimize our symptoms more than men do. (“It’s probably nothing!”).

We self-diagnose more than men. (“”Maybe I just pulled a muscle!”).

We apologize when we do show up for help: “Sorry to be such a bother!”

See also: 6 reasons women delay seeking medical help in mid-heart attack

The strangest thing about feeling a “sense of impending doom” is that this can often emerge before any physical symptoms do. It’s typically experienced as a sinking feeling that something very, very bad is about to happen, including one or more of the following overwhelming sensations:

• a sense of urgency
• being unable to “settle down”
• feeling anxious, discouraged, restless or uncertain (to an extreme)
• a terrifying premonition that you are dying

One study investigated the experience of patients who had developed cardiac tamponade (a life-threatening heart condition in which blood accumulates between the membranes lining the heart, restricting the ability of the heart muscle to keep beating).  Researchers found that almost 90 per cent of patients studied reported a profoundly intense emotional unease or discomfort before the first onset of their physical symptoms.” (1)

And it’s not only heart patients who experience this distressing early warning response.

♥ For example, as Dr. Lynne Eldridge pointed out in her Very Well Health column,  both epileptic aura and non-epileptic seizures can cause a sense of impending doom. And she added:

“Dogs can sometimes detect some of the changes that precede seizures, which they are able to recognize even before the seizure starts.This is why people with seizure conditions may opt to have a seizure-alert service dog.” 

♥  Getting a blood transfusion may also trigger allergic reactions (anaphylaxis) with breakdown of the transfused red blood cells. Symptoms of impending doom occur before other symptoms like shortness of breath or palpitations appear, along with a dangerous drop in blood pressure.

♥  Even worse than the “maddening pain” of being stung by the irukandji jellyfish in the northern waters off Australia is the overwhelming feeling reported by survivors that death was imminent. The toxic effects of venom (or, in other non-sting incidents, toxins like cyanide poisoning) are what seem to trigger these unique sensations.

♥  Intraoperative awareness: Sometimes people “wake up” during surgery, also called anesthesia awareness or unintended awareness. It’s rare (estimated at only about one per cent of all surgical patients) yet it’s a devastating complication when it does occur. A severe form of this problem is called intraoperative awareness with recall – which is the development of post-traumatic stress disorder (PTSD) symptoms like depression, anxiety attacks, sleep disorders, flashbacks to the experience, and recurring nightmares from the events experienced in mid-surgery.

♥  Pheochromocytoma is a type of adrenal gland tumour often caused by a massive release of adrenaline, noradrenaline and dopamine. These chemical hormones can cause a sudden increase in blood pressure, a rapid heart rate, sweating, and that sense of impending doom.

♥  Pulmonary embolism: These are dangerous clots that travel to the lungs, usually after breaking off in the leg (deep vein thrombosis). Other symptoms often include that sense of impending doom, the sudden onset of sharp chest pain, which increases with every  deep breath; patients often feel lightheaded and may become unconsciousness.

♥  Anxiety or panic disorders: Anxiety or panic conditions often worsen over time without professional intervention. People who experience anxiety or panic attacks may become overly aware of physical reactions, such as rapid breathing, increased heart rate and perspiration. And as Dr. Sanam Hafeez, a neuropsychologist at Columbia University, described these truly distressing symptoms to an MSN interviewer:

“They might feel like they are dying, their house is about to burn down, or their plane is about to crash – even when there is no apparent danger.”

Dr. Eldridge recommends calling 911 when  you experience an overwhelming sense of impending doom especially if you are also experiencing other symptoms of a potential medical emergency, such as chest pain that radiates to neck, back, shoulders, jaw, left or right arm, shortness of breath, heart palpitations, nausea, vomiting or unexplained sweating.

Many patients, she adds, “may have stayed alive due to trusting their instinct and intuition”.

Resources:  Mayo Clinic, McGill University Behavioural Medicine Lab, Stanford Medicine, Cleveland Clinic, Dr. Sam Torbati (Cedars-Sinai)

♥

1. Ikematsu Y et al. “Patients’ descriptions of dysphoria associated with cardiac tamponade.” Heart Lung. 2012;41(3):264-70.

Image:  Scary tree, Airgilstudio at Pixabay

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Q:  Have you ever experienced that sense of impending doom during a medical crisis?

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NOTE FROM CAROLYN:  I wrote much more about women’s cardiac symptoms in my book, A Woman’s Guide to Living with Heart Disease. (Johns Hopkins University Press). You can ask for it at your local library or favourite bookshop (please support your independent neighbourhood booksellers!) 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 30% off the list price).