At last! This long-awaited first-ever Guideline for the Evaluation and Diagnosis of Chest Pain for physicians and their patients has done a deep dive to help improve accuracy in evaluating and diagnosing cardiac symptoms(1) – a huge and overwhelming effort. I’m hopeful that updated guidelines might represent a turning point for all women presenting with those symptoms – and for the physicians who diagnose them. Here’s my take on the impressive new Chest Pain Guideline – along with a few concerns: . . Continue reading “New chest pain guideline: “atypical” is OUT!”
“Discharge from the hospital is a highly difficult time for both patients and families, who are often under-supported. Our study found that the levels of the stress hormone cortisol in heart attack patients increased sharply after hospital discharge – and they can stay elevated for months.”
The study that Dr. Doreen Rabi described to me may help to answer the question that so many of my Heart Sisters readers have been asking for years: Why do I feel worse after my heart attack before I start to feel better? . . . Continue reading “Post-heart attack: why we feel worse before we feel better”
“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 over 90% 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. Continue reading “85% of hospital admissions for chest pain are NOT heart attack”
As I’ve noted here previously, there were a number of very good reasons that I believed that Emergency Department physician who sent me home with an acid reflux misdiagnosis. Despite my textbook heart attack symptoms of central chest pain, nausea, sweating and pain down my left arm, these reasons included:
1. He had the letters M.D. after his name;
2. He misdiagnosed me in a decisively authoritative manner;
3. I wanted to believe him because I’d much rather have indigestion than heart disease, thank you very much;
4. The Emergency nurse scolded me privately about my questions to this doctor, warning me: “He is a very good doctor, and he does not like to be questioned!” (The questions I’d been asking included, not surprisingly: “But Doctor, what about this pain down my left arm?”);
5. Most of all, what I had always imagined a heart attack looking like (clutching one’s chest in agony, falling down unconscious, 911, ambulance, sirens, CPR) was not at all what I was experiencing. Instead, despite my alarming symptoms, I was still able to walk, talk, think and generally behave like a normally functioning person, i.e. one who is definitely NOT having a heart attack!*
So it all made sense to me as I was being sent home from Emergency that day, feeling very embarrassed because I had clearly been making a big fuss over nothing.
My experience, however, might have been what researchers in Ireland refer to as “slow-onset myocardial infarction”. Continue reading “Slow-onset heart attack: the trickster that fools us”
A New York study has revisited the issue of stent-happy cardiologists implanting the tiny metal devices that help prop open – or revascularize – blocked coronary arteries. Essentially, this study(1) suggests that two-thirds of the justifications for this procedure in non-emergency patients were either “uncertain” or “inappropriate“. For any heart patient who has ever been told by those with the letters M.D. after their names that this type of cardiac intervention was recommended, it’s yet more troubling news. And the fact that this issue simply will not go away makes me wonder why cardiologists themselves are keeping suspiciously mum about the controversy.
When cardiologists do speak up, not surprisingly, many hasten to pre-emptively defend their interventional colleagues. An editorial that accompanied this study’s publication in the Journal of the American College of Cardiology, for example, explained:
“There are certain to be patients rated as ‘inappropriate’ for which almost all competent cardiologists would recommend intervention.”
In other words, pay no attention to the man behind the curtain. Continue reading “Did you really need that coronary stent?”
After the first attack of severe chest pain, the 61-year old woman spent the night in the hospital’s Emergency Department hooked up to a heart monitor, felt better after a few hours, and was discharged in the morning. Even though she had no cardiac risk factors, her blood tests showed that her cardiac enzymes were somewhat elevated, she described a “too-much-adrenaline” feeling, and she had also failed a cardiac treadmill stress test because of heart rate arrythmias. No positive diagnosis was made at the time, although a condition called myocarditis was suggested.
Then nine uneventful years later, a second attack occurred, this one during a very traumatic period in her life, in hospital for a colon resection operation due to cancer. She describes it like this: Continue reading “Yes, Virginia, there is such a thing as a broken heart”