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Heart Disease (Expert Forum)
Identifying Symptoms
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
Identifying Symptoms
by DannyFHJr, Jun 21, 2002 12:00AM
I don't know if there's an actual answer to this question but I've seen references made in other posts that lead to think there might be.
My brother is in his mid-30's. He's out of shape and overweight, but generally in good health. Since he was a teenager, he's occasionally experienced symptoms of a heart attack -- pain in his left arm, sweating, chest pains, shortness of breath, etc. There have been occasions where we have rushed him to the emergency room only to be told that his EKG and blood tests are all normal. During one visit the doctor thought they heard a clicking sound and sent him for an echocardiogram, but that too turned out to be normal.
In his mid-20's he was diagnosed with severe anxiety manifested as hypochondria and started receiving treatment for it. Since then the episodes have decreased dramatically, but they still occur.
My question -- is there any way or are there any tell-tale signs to identify symptoms of a true heart attack versus an anxiety attack? My family is nervous that eventually someone will discount his symptoms as just anxiety when he could be having a real problem. One doctor suggested to him that if he were having a real heart attack the pain would be unlike anything he'd ever experienced in his life, but of course just telling him that was enough to trigger an episode. I'm convinced that if he didn't know the symptoms of a heart attack he wouldn't display them.
Thanks for any help you can provide.
My brother is in his mid-30's. He's out of shape and overweight, but generally in good health. Since he was a teenager, he's occasionally experienced symptoms of a heart attack -- pain in his left arm, sweating, chest pains, shortness of breath, etc. There have been occasions where we have rushed him to the emergency room only to be told that his EKG and blood tests are all normal. During one visit the doctor thought they heard a clicking sound and sent him for an echocardiogram, but that too turned out to be normal.
In his mid-20's he was diagnosed with severe anxiety manifested as hypochondria and started receiving treatment for it. Since then the episodes have decreased dramatically, but they still occur.
My question -- is there any way or are there any tell-tale signs to identify symptoms of a true heart attack versus an anxiety attack? My family is nervous that eventually someone will discount his symptoms as just anxiety when he could be having a real problem. One doctor suggested to him that if he were having a real heart attack the pain would be unlike anything he'd ever experienced in his life, but of course just telling him that was enough to trigger an episode. I'm convinced that if he didn't know the symptoms of a heart attack he wouldn't display them.
Thanks for any help you can provide.
Doctor's Answer
by CCF-M.D.-RCJ, Jun 21, 2002 12:00AM
DannyFHJr,
Unfortunately, no physical exam finding or historical feature is reliable enough to diagnose or exclude a heart attack. A careful review of the medical literature reveals that the description of the pain (pressure vs sharp vs burning, etc), the location of the pain, the associated symptoms (nausea, shortness of breath, lightheadedness, sweating), the severity of the pain, the relief of the pain with medicines all mean very little when trying to diagnose a heart attack.
What is essential in the diagnosis is the entirety of the history and physical by a thoughtful physician. In the majority of cases, the history and physical must be accompanied by further testing, which might include an EKG and bloodwork.
An article in this week's New England Journal of Medicine describes a potential mechanism for "Cardiac Syndrome X" -- the presence of episodic chest pain in the face of normal heart arteries. This article demonstrates a lack of blood flow to a portion of the heart called the subendocardium in some patients with this syndrome. The long-term significance of this finding is not decisively known, but most cardiologists feel that these patients have an excellent prognosis (data from observational studies).
Hope that helps.
Unfortunately, no physical exam finding or historical feature is reliable enough to diagnose or exclude a heart attack. A careful review of the medical literature reveals that the description of the pain (pressure vs sharp vs burning, etc), the location of the pain, the associated symptoms (nausea, shortness of breath, lightheadedness, sweating), the severity of the pain, the relief of the pain with medicines all mean very little when trying to diagnose a heart attack.
What is essential in the diagnosis is the entirety of the history and physical by a thoughtful physician. In the majority of cases, the history and physical must be accompanied by further testing, which might include an EKG and bloodwork.
An article in this week's New England Journal of Medicine describes a potential mechanism for "Cardiac Syndrome X" -- the presence of episodic chest pain in the face of normal heart arteries. This article demonstrates a lack of blood flow to a portion of the heart called the subendocardium in some patients with this syndrome. The long-term significance of this finding is not decisively known, but most cardiologists feel that these patients have an excellent prognosis (data from observational studies).
Hope that helps.
Member Comments (2)
by Cinderally, Jun 23, 2002 12:00AM
Hello all. I am not a doctor, but couldn't the brother's symptoms be more related to mitral valve prolapse? I think this disorder can cause the symptoms you are describing and they do occur in younger patients.
