Tribune Print Share Text

Title

A heart attack or not?

Created date

October 22nd, 2014
heart graphic
heart graphic

If you have chest pain, the first thought that comes into your head might be that you’re having a heart attack. That’s not necessarily the case. “Chest pain can be related to any number of body organs and tissues,” says Lora Cox-Vance, M.D., geriatric fellowship director at University of Pittsburgh Medical Center., St. Margaret Hospital. “It can be difficult to determine what is or is not an emergency.”

Every year, according to the Centers for Disease Control and Prevention, about 720,000 people in the U.S. have a heart attack. Approximately 515,000 of these people are having their first heart attack, and 205,000 have already had one or more. A blockage in a coronary artery is the most common reason for heart attacks.

“The textbook symptoms of a heart attack are usually left-sided chest pain or pressure that radiates to the jaw or left arm; sweatiness; shortness of breath; nausea and sometimes vomiting; feeling cold and clammy; and lightheadedness,” says Sangeetha Shan-Bala, M.D., staff physician at Greenspring, an Erickson Living community in Springfield, Va. “Someone might have all of these symptoms or only one or two.” 

Compared to younger or middle-aged adults, seniors may have different heart attack symptoms—sometimes because of normal aging’s effect on the body. “The symptoms may be blunted or entirely absent because of changes in the structure and sensitivity of the nerves,” Cox-Vance says. “Vague symptoms such as weakness or fatigue may not get your attention because you have them on a regular basis due to another medical condition.” 

According to the American Heart Association, older women in particular may have fewer classic signs of a heart attack and therefore not seek treatment. “They may experience a little chest pressure, shortness of breath, or just feel tired,” Cox-Vance says. “Some women might think that it can’t be a heart attack because there’s no dramatic chest pain or pressure. If you are ever in doubt, call 911.”

More heart-related causes

“Any one of the four valves in the heart can become less elastic and restrict blood flow, which also causes chest pain,” Cox-Vance explains. “People with valve disease tend to have chest pain or tightness, get short of breath, and they may lose consciousness—especially if they are exerting themselves. Symptoms may resolve with rest, but should be evaluated by your physician. 

Less common reasons for chest pain can be inflammatory conditions such as pericarditis, when the sac around the heart swells due to an infection, injury, certain medications, or another reason. “The type of pain associated with pericarditis tends to be very sudden and sharp, and it may ease somewhat when you change position,” Cox-Vance says.

Practically any type of heart disease can produce some form of chest discomfort. A notable exception is heart failure. According to the National Institute on Aging, heart failure is the number one reason people over age 65 are hospitalized, but the primary symptoms are shortness of breath; fatigue; and swelling of the feet, ankles, legs, or abdomen. A few people with this condition may experience chest pain, but most don’t.

From your head to your heart

Some emotional problems can lead to chest pain. “Anxiety disorders and panic attacks can cause symptoms that mimic a heart attack,” Shan-Bala says. “But unless you have an underlying medical problem, these episodes don’t damage your heart.”

On the other hand, you can be seriously disabled or even die from a broken heart. “This is known as stress-induced cardiomyopathy or takotsubo cardiomyopathy,” Shan-Bala says. “It’s caused by an excess of stress hormones that flood your system and damage your heart when you’ve had an emotional shock—such as a spouse’s death. The symptoms are similar or identical to a heart attack.” This syndrome can also occur because of a “good” shock, such as winning the lottery.

Chest pain from other organs

“Many of the nerves in your trunk are interrelated,” Shan-Bala says. “That’s why pain originating from one organ can feel as if it’s coming from somewhere else.”

Lungs. “Chest pain that originates in the lungs may be  due to inflammation of the pleura—the lining that protects the lungs,” Cox-Vance says. “Pneumonia is a common cause of pleuritis. This type of pain tends to worsen when you take a deep breath.”

A very sudden and sharp pain may be due to a pulmonary embolus. “This is an emergency situation in which a lung artery becomes blocked, most often from a blood clot that has broken off from a leg vein,” Shan-Bala says. “The other main symptom is difficulty breathing.”

Bones and muscles. “A fairly common reason many seniors have chest pain is problems with bones, muscles, or other soft tissues in the chest or back,” Shan-Bala says. “Costochondritis, or inflammation of the cartilage that attaches the ribs to the breastbone, feels similar to heart attack pain. Pain can also travel along the nerves from the thoracic discs in the back.” 

Gastrointestinal tract. Disorders including acid reflux, peptic ulcers, hiatal hernia, or esophagitis can produce pain in the chest area. “These conditions can cause chest pain after eating,” Cox-Vance says.

The bottom line

If you have had chest pain on and off for a long time that’s associated with a non-life-threatening condition, you may not need to seek emergency care every time it occurs. If you notice a difference in the quality or timing of the pain, however, seek treatment. 

 

Comments