Article Contributed on: 2/25/2008 12:42:04 PM
2/25/08 10:56 AM
Awoke 8AM today with limited small area persistent Left parasternal/substernal chest pain, real, but not too extreme, wouldn't go away. No other symptoms. B.P. 135/80, P 96. Shortly took an aciphex (stops acid production cold), then about 15 minutes later a large swallow of the antacid Mylanta. Used computer for about 1/2 hr. Raised electric head of bed; went back to bed. Awoke 10:50 with no pain. Presumably GERD.
I would have taken a more vigorous approach, perhaps with a trip to the hospital or doctor; if there had been any ominous accompanying signs, such as:
Severe, crushing chest pain; pain radiating up to neck or jaw, or to the back, pain radiating down arm, particularly to little finger; SOB (shortness of breath) or marked weakness or dizziness (complicated by the fact that I have "ongoing central vertigo" mitigated by meclizine). Also, if I did not know I had GERD (gastroesophageal reflux and a hiatus hernia), would view symptoms with more alarm. It's not a bad idea to have the "cardiac cocktail" of a liquid antacid to gulp down if all you have is the single area of non-crushing chest pain. You might also consider taking an acid-production-stopper like Aciphex, but that is not part of the usual "cardiac cocktail".
Of course, for the layman, if you have doubts at all, you would be better advised to hie yourself off to a Doctor or Emergency Room immediately, as there may be no second chance.
You may think my view of this "attack" is rather too cavalier. If my Blog stops and my eMails stop coming, you may be right.
But, consider that a close friend of my friend in Sweden who went to the hospital one night. They diagnosed a small heart attack. The doctor told him that there was less than one chance in three that he would have another heart attack within 24 hours (approximately same statistics we use here in the U.S.). But, the doctor said they have a chronic shortage of beds in their "socialist system" and so since the danger wasn't great, would he mind going back home, and then coming in only if he had a sudden exacerbation of his symptoms? This seemed reasonable to him, and so he went back home.
They not only have a quite different socialized medicine system in Sweden, but they have a different view than we do.
We in the U.S. take a more aggressive view, and when a patient came in with chest pain and saw me, many years ago when I was the intern in charge of the large emergency department, and he had vomited and had chest pain at home, and was still sweaty; I entreated his wife to have him admitted, because I thought there was a very considerable chance that he had had a heart attack. Even though his ECG was normal (since heart damage adjacent to the diaphragm will not show on the old standard ECG in use at that time).
She was furious at us, shouting that we just wanted his money (I didn't point out that I got $100.00/month, board and a single room as an intern). An infarct on the posterior-inferior wall of the heart will often cause vomiting - which is why our great-grandparents were often signed off on the medical report as "Death from Acute Indigestion". Signing someone out as dying of Acute Indigestion was particularly more common when the elected coroner had a high school degree only (which is common in many U.S. counties today).
This patient with the vomiting and sweatiness and chest pain at home, had a second massive heart attack about 4AM that morning and died in spite of our best efforts; but at least, his wife didn't have that on her conscience.
I accompanied the "Czar of Swedish Medicine" for almost 2 weeks during a teaching/learning trip to Denmark and Sweden in which the American Radiologists taught the Scandinavians for a half day, then the Scandinavians taught us the other half day. There are many differences in Medicine in Sweden. They have a homogeneous population (without the illiterate whites and minorities found in some pockets of our country); and can be taught more easily because of this homogeneity. I was privately informed that in England when a newborn was dramatically deformed, presumably severely retarded, and stood no chance of having more than a bedridden vegetative existence, the doctors and nurses would observe the newborn for awhile to see if it breathed on its own, and if not "pronounce it a stillbirth". I wonder if the view is similar in Sweden.
In the U.S. we would engage all possible medical personnel and supertechnical equipment, spend money like water, and take drastic measures to save the newborn; and if it died "pronounce it a neonatal death". This can clearly account for some of the disparity between countries as they list their mortality rates. There is probably something that could be said for either approach.
Del Knudson, M.D.