One of the most common complaint we see in medicine is Chest Pain. It starts with that twinge in your chest. Then you notice your left arm feels funny; and didn’t your great uncle Fred die of a heart attack? After all, you did smoke a cigarette one time in college. Is it your heart? Thats the first thing that goes through your mind. Mostly it goes through your mind and keeps on going. But now and then it goes in your mind and sticks.
Cool fact number one: the heart does not have pain receptors. The heart cannot itself feel pain. So what do we feel? How do we know when our heart is truly in distress?
Cool fact number two: you cannot feel high cholesterol. Damage from high cholesterol develops over decades. It does not suddenly cause a sharp pain in the middle of your chest.
So what do we feel and when do we worry. The heart is simply a muscle; one that’s contracts and relaxes 70 to 80 times a minute every hour of every day of your life (hopefully 80 or more years). What we feel when the heart is in distress is the secondary effects when the rest of the body doesn’t get the regular flow and pressure of blood. Then when we push the body a little bit, the symptoms get worse. And when we stop and relax, the symptoms get a little better.
Since the heart does not have any pain nerves, what do we feel? The chest has a network of diffuse nerves, not a point to point system. These sensations are all referred and ‘secondary’ sensations. That’s why your left arm or maybe your left jaw has a weird ache that wont go away. Or maybe you’re having a hard time breathing but you’re not exerting your self. Some describe it as an elephant sitting on your chest. The Vagus nerve runs right behind the heart along the esophagus. When the heart gets in distress the Vagus nerve feels this and suddenly you break out in a sweat and you’re nauseaus. Maybe you feel a pounding in your chest. Unfortunately, this is when denial kicks in and you really try hard to convince yourself that everything is just fine.
So, what do we do? I just threw out all the things that were worrying you so you are certainly worrying over nothing. What if everything I just said is wrong? Unfortunately, everything I just said is wrong but at the same time right (except for the heart pain and cholesterol; those are true).
We know the signs of a heart attack. We have been trained and have had the symptoms drilled into us for years on end. And the not so cool fact number three is you cannot diagnose your own heart attack. You might be right but you could be wrong. Yours is a guess, we will give you an exam and objective findings that will tell you if you are truly heading to the hospital or back to home. I can honestly say there are people walking on this earth today because they came is hoping it was nothing but listened to me when I said it was truly their heart.
Some people don’t come in because they might feel embarrassed. Believe me, there’s is nothing at all to be embarrassed about. My own father was in denial for two weeks before I convinced him to go to the ER (and he was having a heart attack). So, if you are having anything that feels wrong or different that worries you that “it might be your heart”, the easiest thing you can do is come is and let us take a look. More often than not we get to send you home with the confidence that everything is OK. But if we do send you to the ER, statistically there is a 0.4% chance it is your heart and at this stage you will still be fine (just with some new parts and a medication or two).
