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AM I HAVING A HEART ATTACK?

15 Feb

Chest pain -MI
When Peter  got in the car at 12.30am and drove from the house his wife looked out of the window she thought “he must be going to his mother’s and went back to bed. How wrong she was because Peter aged 65 yrs had woken with pain in the chest and recognised that this was something different and he knew he had to seek medical advice immediately. He drove himself to the nearest hospital and soon was diagnosed with a heart attack and after emergency treatment was transferred to a neighbouring hospital to have a stent inserted.
Peter is retired but a Type A personality ‘on the go’ involved in as many organisations he can fit into his life and certainly not someone to wait for things to happen!
He now puts as much energy into his Cardiac Rehabilitation as he puts into chairing a meeting.

Similarly, when Lucy 39 yrs a research biologist, pregnant with her third child telephoned me one evening and described her heavy central chest pain and how she felt very anxious, sweaty and was short of breath my reaction was to tell her to go straight to A&E and she was also diagnosed with a heart attack and subsequently went on to have a stent inserted. A surprising diagnosis as she was slim, a non smoker and young but nevertheless the presenting symptoms raised the alarm bells.

Likewise, when Dai 56 yrs came to the surgery with the story of increasing heaviness in the chest with breathlessness a week ago after rolling a barrel of beer up to ‘the Club’ as the Brewery lorry had broken down on the hill. He was revived with a glass of brandy but an ECG later demonstrated that he had suffered a heart attack.

In the same way, Bill who was a 60 yrs old bo’sun on a sailing ship and described severe indigestion when at sea, worse on exercise and again on investigation shown to have had a heart attack and subsequently had a quadruple bypass and in due course went back to sea.
In all these cases the patient had that feeling that their pain was different and overwhelmed with anxiety and fear that it may be cardiac.

Even if the pain is not assumed to be cardiac pain initially if other risk factors are taken into account such as in the case of Mrs.Patel, a 65yr old diabetic who had developed some vague chest pain on exercise and was worried, on further investigation was found to have had a ‘silent’ heart attack and subsequently followed up by a triple bypass.

As a medical student we are also told of the unpredictability of the heart and my first tutorial with a cardiologist was that of his examining a patient, reassuring them that there heart was in good order and the patient dying at the bus stop with a heart attack. Most of us are aware of this by hearing of a friend, relative or celebrity dying in the same way, but for the most part there is adequate warning.

All these stories remind us that coronary artery disease is out there and can strike at anytime in many different forms and often the chest pain is not the main feature and can be in different parts of the upper body.
Heart attack

It is for this reasons that doctors have joined together to formulate a scoring system of chest which is based on signs and symptoms which are relatively easy to recognise and can dictate how urgently action should be taken. In all the examples of the above patients presenting with chest pain each person would have scored at least 3 points.

 Components of the Marburg Heart Score
Score component Assigned points

  • Age/gender (female ≥ 65, male ≥ 55). 1
  • Known clinical vascular disease 1
  • Patient assumes cardiac origin of pain 1
  • Pain worse with exercise. 1
  • Pain not reproducible by palpation. 1

1 point is assigned for each score variable. 3 different risk categories are derived:
low risk = 0–2 points; intermediate risk = 3 points; high risk 4–5 points.

If you or someone with you scores >3 points and you strongly suspect they are having a heart attack it is important to act immediately:-

    • Dial 999 and ask for an ambulance if you suspect that you or someone you know is having a heart attack.
    • If the casualty is not allergic to aspirin and it’s easily available, give them a tablet (ideally 300mg) to slowly chew and then swallow while waiting for the ambulance to arrive

The aspirin will help to thin the blood and restore blood supply to the heart.In my early career this life threatening pain could only be treated with very strong painkillers such as diamorphine commonly known as heroin (an important component of my doctors bag at the beginning of my career) and bed-rest and watchful waiting preferably at home.Now for treating Heart attacks there are two main treatment options for people with the most serious form of heart attack; an ST segment elevation myocardial infarction (STEMI):

  • a combination of medication to dissolve the blood clot and restore the flow of blood to the heart (this is known as thrombolysis)
  • surgery to widen the coronary artery, which is usually done using a technique called coronary angioplasty.

To read more about heart attack:-
http://www.nhs.uk/conditions/heart-attack/Pages/Introduction.aspx

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Posted by on February 15, 2014 in Training and Advice

 

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