Chest pain is one of the most difficult symptoms patients ever have to face. It often causes severe anxiety and distress since coronary artery disease is the number one cause of death in the United States. Patients are likely to seek emergency treatment urgently. Chest pain evaluations in the emergency room amount to 8-10 million patients annually according to Mayo clinic article 2010. Chest pain actually accounts for about 5 to 10 % of the total emergency room (ER) visits. The cumulative cost of evaluation in the emergency room exceeds $8 billion. It is imperative to have rapid management and control of patients during these situations.
The symptoms of heart attack are chest pain or chest heaviness, nausea, sweating, shortness of breath, and numbness of the left side of the body down to left arm. Up to 30% patients, such as diabetics, may have minimal or no symptoms. This is also called “silent MI.” A person who experiences chest pain should call 911 and get an ambulance to reach the hospital. It is not advisable to use their car to go to the ER. Since the average response time for an ambulance is about ten minutes, time should not be squandered on streets with traffic lights.
Paramedics are trained to evaluate patients, start intravenous line, do electrocardiogram, administer medication, defibrillation for arrhythmia, and perform CPR in case of cardiac arrest. These services are not available while going with car. Ambulances bypass the triage and the ER doctor is notified ahead of time. Patients coming by car must fill out forms and wait in line for triage nurse, wasting a lot of precious time. We must realise that time is muscle.
It is also very important not to go to physician’s office if you are having acute onset of chest pain. Your physician may not be accustomed to treating heart attack patients. Also he may not have the necessary tools and equipment required to deal with the situation. Speed and efficiency are essential. Time is muscle means more times wasted before getting treatment the more heart muscle will be destroyed. There is valuable time lost if a patient is taken to the physician’s office instead of directly to ER.
A heart attack occurs when blood clots in an artery clogged with cholesterol deposits. This deprives the heart muscles of much needed oxygen in the blood. Consequently, the tissues cannot operate and muscles collapse. Success in the emergency room is measured by how fast these patients get treated. The patient will most likely have an electrocardiogram, blood tests including cardiac enzyme markers, oxygen, nitroglycerin, as well as aspirin therapy. After history and physical exam, if the EKG is consistent with acute heart attack, then a cardiologist is notified immediately. The clot busting drug may be administered even before the arrival of the cardiologist. The patient can also be taken immediately to cardiac catheterisation lab to open the blocked artery. Some patients may require placement of a stent to prevent the artery from closing.
There is some chest pain of non-cardiac origin also but only a physician after proper evaluation can determine that. Usually chest pain of prolong duration can be from other than heart. For example, patients with chest bone inflammation can have pain of prolong duration. Pleurisy or inflammation of lung due to viral aetiology will cause pain on deep breath. Even heart burn can look like chest pain; other aetiology like panic attack or just anxiety can manifest as chest pain as well.
Chest pain is a symptom which must not be ignored or taken lightly. Prompt evaluation is of paramount importance to save heart muscle. A rapid response and proper treatment can save lives and prevent long term complications.
[Dr. Ansari is board certified in Internal Medicine and Nephrology and practices at Medical Associates at Clinton, Iowa, United States]