A vexing question that millions of Americans...and their doctors...face each year is whether a chest pain is due to a heart attack or something else, because chest pain can stem from dozens of conditions besides heart attack, from pancreatitis to pneumonia or panic attack, says the May 2010 issue of the Harvard Heart Letter.

Last year, of the more than 6 million Americans with chest pain seen in hospital emergency rooms, only 20 percent were having a heart attack or an episode of unstable angina, a warning sign that a heart attack may happen soon, adds the heart letter.

While a small percentage had another potentially life-threatening problem, such as pulmonary embolism (a blood clot in the lungs) or aortic dissection (a tear in the inner layer of the aorta) and some were experiencing “regular” angina, which occurs when part of the heart isn’t getting as much oxygen-rich blood as it needs during periods of physical exertion or emotional stress, most of the six million had a condition unrelated to the heart or arteries.

Another tricky problem with heart attacks is that different individuals experience them in different ways, ranging from classic chest pain, jaw pain or back pain to becoming breathless, extremely fatigued or nauseated.

The most accurate information needed to determine which individual is, and which one isn’t, having a heart attack is the results of blood tests for markers that show damage to the heart muscle, such as creatine kinase and cardiac troponin.

However, it takes awhile for blood levels of these proteins to get measurably high, so the best early methods are an electrocardiogram (ECG) to measure the electrical activity in the heart plus your story and description of the chest pain and other symptoms.

The other things your doctor will want to know about what you are experiencing are:

• What you are feeling...pain, pressure, tightness, etc.

• Where the discomfort is

• When it started

• Whether it has gotten worse or stayed the same

• If the feeling is constant or it comes and goes

• If you have felt it before

• What you were doing before these feelings started

Chest pain is not something to shrug off until tomorrow or diagnose at home, says the heart letter.

Don’t play doctor...go see one, fast, if you are worried about pain or discomfort in your chest, upper back, left arm or jaw, or suddenly faint or develop a cold sweat, nausea or vomiting, warns the letter.

Call 911 or your local emergency number to summon emergency medical crew who can rush you to the hospital in a vehicle full of equipment that can start the diagnosis and keep you stable if your heart really is in trouble, advises the heart letter.

The heart letter enumerates many reasons given to delay calling for help, including:

• “I’m too young” — You are not...even 20-somethings can have heart attacks.

• “I’m in great shape” — A heart attack is sometimes the first sign of heart disease.

• “I have a family to take care of” — All the more reason to get to the hospital fast.

• “I don’t want to bother anyone” — You’d be a bigger bother with advanced heart failure, or dead.

A list of heart attack warning signs are offered:

1) Chest pain — This is only one of the possible signs of an impending heart attack.

2) Uncomfortable pressure, squeezing, fullness, burning, tightness or pain in the center of the chest

3) Pain, numbness, pinching, prickling or other uncomfortable sensations in one or both arms, the back, neck, jaw or stomach

4) Shortness of breath

5) Sudden nausea or vomiting

6) Lightheadedness or dizziness

7) Unusual fatigue

8) Heat/flushing or a cold sweat

9) Sudden heaviness, weakness or aching in one or both arms
Although taking immediate action may turn out later to be a false alarm, don’t worry about anyone getting mad at you for crying wolf, says the heart letter. You will be evaluated as if you were having a heart attack and, when it is ruled out as the cause of your symptoms, your doctors will look for the real cause...whether it be indigestion, panic attack or another possibly recurring condition.
Thus, if you think your chest pain or discomfort might be due to a heart attack, take action right away...the sooner you are checked out, the sooner you can get artery-opening therapy that can protect your heart from permanent damage, concludes the letter.

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