Heart Attack Symptom — chest pain

December 13, 2007 – 9:36 am

How do you know if it’s a Heart Attack Symptom?

Before I get into the generalities, let me tell you I understand!

It’s not fun to wonder about this. I know that myself. The last few days I had some upper body / chest pain, and I was really concerned about it! The first time it happened, I was driving my car thinking, is this a heart attack symptom? I realized I didn’t have my cell phone with me to call 911 or my wife!

But I ran through an internal checklist-

Is the pain in the center of my chest? Not exactly, but close…
Does it feel like an elephant is sitting on my chest? No, it’s not that heavy…
Do I have a sense of dread? No, just concerned about what it is…
Is there any radiating pain down my right arm? Nope.
How’s my heartrate? I felt the jugular artery in my neck, and it seemed normal.

Ok, I thought, it’s probably not a heart attack symptom, but what is it?

Well, when we medical professionals are confronted with something like chest pain (also called angina), we have to know which diseases it could turn out to be. It might be a heart attack symptom, or pancreatitis, or GERD, or intercostal chondritis, and so on. We have a mental list of the possible diseases, and we do what’s called differential diagnosis to determine which one it is. We do that differential by both asking questions and using objective information like the patient’s physical status, appearance, lab tests, visual imaging, etc.

Instead of just listing the possible diagnoses, I’ll give you a table of the diseases and their characteristic symptoms and presentations (see below the table for abbreviations, which I had to use to fit the table in!). Note that MI means myocardial infarction, and is the same as heart attack.

Heart Attack Symptom Table (Chest Pain Diseases)

Diseases:

Ang

MI

AD

PE

ER

ES

SPMS

SPTX

Peric

Musc
VI
CC

EPl

MVP

CF

Sudden

Gradual

Pressure sensation

Tearing sensation ÿ ÿ ÿ ÿ ÿ ÿ ÿ ÿ ÿ ÿ ÿ ÿ

Sharp stabbing pain

worse w/(ww) Stress

ww:Hypertension

ÿ

ww:Breath/cough

ÿ

ww:Swallowing/vomiting

ÿ

ww:Laying down face up

ÿ

ww:Movement

ÿ

radiates to arm/shoulder

ÿ

radiates to back

raditates to neck/throat/jaw

ÿ

rib pain, tenderness, swelling

Key to table: ww = worse with, Ang=angina (chest pain), MI = myocardial infarction (heart muscle death, or heart attack), AD = aortic dissection. PE = pulmonary embolism, ER = esophageal rupture, ES = esophageal spasm, SPMS = spontaneous pneumomediastinum, SPTX = spontaneous pneumothorax, Peric = pericarditis, Musc = musculoskeletal chest pain, VI = vertebral impingement (with referred dermatomal pain), CC = chostochondritis, EPl = epidemic pleurodynia, MVP = mitral valve prolapse, CF = cough fracture.

I know you want to know… was mine a heart attack symptom?

It turns out that my supposed heart attack symptom was either vertebral impingement or chostochondritis. I’m getting chiropractic treatment for it and I’m going to keep an eye on what makes it worse and better.

If you have any lingering questions or concerns,
see your regular doctor or go to urgent care
or the Emergency Room/Dept.!