“The classic symptom is that elephant sitting on the middle of your chest — this heavy, crushing pressure, mid-chest,” Lloyd-Jones said. “Never ignore that. It’s the most common warning sign.” - Elizabeth von Oehsen/The Washington Post
It Felt Like I Had Indigestion but I Was Having a Heart Attack
By Ken Budd
My symptoms started at least a day before I felt any chest pain. I’d become winded and sweaty after carrying some boxes up and down steps. That evening, I felt pain in my shoulder, neck and back that made it hard to sleep. Twice during the night I woke up sweating.
I assumed my ailments were remnants of a stomach bug — I’d thrown up twice two days before — but when pressure began building in my chest, I thought, Whoa, is this my heart? My dad had died of a sudden massive heart attack years before, so even though I didn’t feel terrible, I went to an emergency room. “I’m sure it’s nothing,” I said sheepishly to the triage nurse, feeling a bit like a hypochondriac.
Less than an hour later, I was rushed by helicopter to a hospital with a cardiac catheterization lab, where doctors can identify potential blockages and possibly reopen a clogged artery.
“Most people will say, ‘You know, a couple days ago, I wasn’t feeling good, I had indigestion’ — there’s usually something that’s not right,” said Alan Schneider, a cardiologist and electrophysiologist who works at Suburban Hospital in Bethesda, where I was treated. “It doesn’t have to be crushing pain.”
Upper body pain is a common if lesser-known indicator of a heart attack. “Anything between the belly button and the forehead could be heart-related symptoms,” said cardiologist Donald M. Lloyd-Jones, immediate past president of the American Heart Association and chair of the Department of Preventive Medicine at Northwestern University’s Feinberg School of Medicine.
Gen Xers like me — I’m 57 — may remember Fred Sanford’s recurring chest-clutching heart attack routines on “ Sanford and Son ,” but the pain isn’t always dramatic. In my case, I experienced a mild discomfort, like a weight was pressed against my ribs, or my chest was overinflated with air.
“The classic symptom is that elephant sitting on the middle of your chest — this heavy, crushing pressure, mid-chest,” Lloyd-Jones said. “Never ignore that. It’s the most common warning sign.”
Other possible warning signs include arm pain (typically on the left side), stomach pain and even pain in your gums or jaw. If discomfort is accompanied by other symptoms such as sweating, shortness of breath, or lightheadedness or feeling faint, consider calling 911. For women, the symptoms of heart attacks can be more diffuse or vague — sudden arm aches, neck or jaw ache, nausea or vomiting, dizziness or being unusually tired.
Also, heart attack symptoms can appear “hours, days, or weeks in advance,” as the Mayo Clinic explains on its website.
Lloyd-Jones’s advice: “If the symptoms seem more common with exertion and they’re better when you rest, that’s a red flag for any doctor to say, ‘Let’s get you in and see what’s going on.’”
One thing that’s not a predictable heart attack warning sign: elevated blood pressure. Mine was high — 156/84 before I went to the ER — but “some types of heart attacks can lead to very low blood pressure,” Lloyd-Jones said.
Other lessons from my experience include:
My approach to health issues is usually, “Eh — I’m sure it’s nothing.” But once I realized that my symptoms matched many of the Mayo Clinic’s warning signs , I went to the ER.
Within an hour of my arrival, cardiologist Yuri Deychak had received an electrocardiogram (EKG) of my heart at his home, diagnosed a blockage in a coronary artery leading to the heart and activated the catheterization lab team at Suburban Hospital to unblock my artery.
“Time is muscle,” Deychak later told me, and it’s a common phrase among cardiologists. To prevent heart cells from dying, doctors need to quickly restore blood flow and oxygen levels. Their goal: to get a patient into a catheterization lab to insert a stent — a tiny expandable metal mesh coil that once in place will keep an artery open — within 90 minutes of experiencing symptoms.
Procrastination can be deadly, as one of my nurses learned. She shared the story of a friend, age 49, who showed signs of a heart attack. The friend called his primary care physician that evening but decided to see if his symptoms improved overnight. By morning he was dead.
Call 911, not Uber (or a friend)
I made a mistake: I asked a friend to drive me to the ER. That’s smarter than driving yourself, experts say, but I should have called 911. If my heart had stopped during the drive, EMTs could have treated me immediately. They have a defibrillator to restart a heart, an EKG machine to test your heart rhythm, lifesaving medications, and they know which hospitals have the right facilities to treat a heart problem. My friend took me to the nearest hospital, but it didn’t have a catheterization lab, which is why I ended up having to be flown by helicopter to one that did.
A cath lab is mandatory for unblocking an artery
The New Jersey-based Atlantic Health System found that heart attack patients who called 911 received treatment 30 minutes faster on average than those who drove themselves. Yet many patients, like me, don’t make that call. My symptoms seemed mild, so 911 felt extreme and an ambulance can be costly depending on circumstances.
Some heart attack sufferers choose ride services like Uber or Lyft. A 2017 study found that ambulance usage rates had dropped by 7 percent in cities where Uber operates. But taking an Uber for a heart attack is no safer than riding with a friend, since your driver’s sedan probably won’t have an EKG machine or defibrillator.
Deychak said he remembers a patient who arrived at the hospital via Uber, then suddenly experienced ventricular fibrillation (a heart arrhythmia that is the most frequent cause of sudden cardiac death). If the driver had arrived even five minutes later, she may have died.
“You want EMTs monitoring you all the way,” Lloyd-Jones said. “If something happens, they can respond instantaneously.”
Having a heart attack is stressful. In the ER at the first hospital, I could hear the alarm in a nurse’s voice after she read my EKG report. I could see the helicopter crew’s concerned faces as they wheeled me to the helipad. In the cath lab, staff darted around the room, shaving parts of me that shouldn’t be shaved, inserting a catheter in an artery and injecting a dye to detect blockages on a screen. (“It’s going to feel hot,” a technician said, and yes, the dye blazed in my arm and my chest.)
And yet to my surprise, the overwhelming emotion I felt was not fear but gratitude. Amid the life-or-death bustle, I felt grateful for the people I love, and the people who love me, and for the team that was treating me. Those peaceful feelings may have reduced the strain on my heart.
For patients who are understandably scared and upset, “one of the treatments we often give in the emergency room is anti-anxiety medicine,” Lloyd-Jones said. “If we can keep the heart rate low, and keep blood pressure moderate, the heart works less hard, and fewer heart muscle cells will die.”
I soon had another reason for gratitude. Once the team had snaked the catheter through my arm to my heart, they expected to find major blockage. But my arteries looked clean. So, what happened?
Doctors suspect that a piece of plaque — fatty buildups on artery walls caused by cholesterol and other substances — had ruptured and clotted an artery, and the clotted plaque passed through on its own. I was incredibly lucky. What if the clot had been larger and hadn’t moved through? Sometimes even slight heart attacks can make patients’ heart rhythm “go haywire,” Deychak said.
Instead, less than 36 hours after the heart attack, I was pacing with my IV pole in my hospital room, ready to be released. Scans showed no damage to my heart muscle. I was lucky.
Now that I’ve had one heart attack, I’m a likely candidate for another, Lloyd-Jones said. It’s clear that plaque can form in my arteries. I largely feel okay — the worst part was two weeks of wrist and arm soreness from the catheter. In the weeks following the heart attack, my EKG readings were irregular, and I experienced occasional heart palpitations, sometimes as often as three to five times a day. But nearly five months after my visit to the cath lab, everything is happily back to normal.
I also have an excellent long-term prognosis, Schneider said. I’ve finished cardiac rehab (picture a gym where everyone wears heart monitors and submits to blood-pressure checks), which helped me lose seven pounds and lower my blood pressure. I’m also taking some new heart meds, including a platelet inhibitor and a daily aspirin, to reduce my risks (I was already taking a statin and beta blocker). Even before the heart attack, I was more likely to eat a salad than a burger, but my doctor suggested that I lower my daily sodium consumption, which has meant some sacrifices — including a favorite: pizza.
But from where I stand now, it’s worth it to prevent a return visit to the ER.
“This was a shot across the bow,” Schneider said. “You could have dropped dead, but instead, here you are, alive.” - Washington Post
