Heart attack - Yes or No?

Chest pain has different causes, but they all have in common that they frighten the affected person. Although up to 90% of the symptoms can be classified as harmless in an initial assessment, rapid action by those affected is nevertheless indicated. Especially in life-threatening situations, every minute is crucial.

Interview with Prof. Dr. med. Christophe Wyss

Prof. Dr. med. Christophe Wyss - Interventional Cardiology - HerzKlinik Hirslanden

Chest pain is a common problem. In the Swiss population as a whole, an average of 1 to 2 percent of all respondents report having experienced chest pain in the last four weeks (women slightly more often than men). It is estimated that 20 to 40 percent of the total population experience chest pain at least once in their lives. Such complaints frighten those affected, and accordingly this is the reason for 4 to 10 percent of all visits to the family doctor.

From harmless to life-threatening

The causes of chest pain are extremely varied, can affect different organ systems in the chest and - depending on the cause - are absolutely harmless or acutely life-threatening. Fortunately, in the general practitioner's practice or in the emergency ward, with targeted questioning, clinical examination and selected additional examinations such as electrocardiogram, blood tests or imaging, approximately 90 percent of all situations can be classified as harmless without the need for further clarification. Only rarely are complex examinations required (e.g. computer tomography, ultrasound examination, angiography), which are only available in emergency wards or hospitals. The primary aim is to exclude dangerous circumstances by means of targeted risk stratification.

Dangerous cardiovascular conditions include myocardial infarction, aortic dissection, hypertensive crisis and pulmonary embolism. In these cases, specific therapy must be initiated without delay, which usually requires rapid hospitalisation or referral to a specialised centre.

Reaction time influences the course

In many acute clinical pictures, the intravenous use of drugs to regulate blood pressure (in the case of derailed blood pressure) or to thin the blood (in the case of pulmonary embolism or suspected thrombosis) should be considered. In the case of myocardial infarction, the occluded coronary vessel must be reopened as quickly as possible with catheter intervention, and in the case of aortic dissection, emergency cardiac surgery is usually required to replace the ruptured aorta.

All these measures should be initiated with the patient in a state of readiness for resuscitation - defibrillator ready for use, competent personnel for resuscitation/cardiac massage on site - as circulatory arrest can occur at any time. A well-functioning network of primary care providers, specialists, rescue services and hospitals is central to efficient patient care.

Any delay in treatment can have fatal consequences for the further course of the disease: In the case of aortic dissection, for example, a quarter of all patients die within the first 24 hours after the event (1 percent mortality rate per hour!); in the case of myocardial infarction, delayed opening of the affected coronary artery results, among other things, in an irreversible loss of valuable heart muscle tissue, which consequently leads to cardiac insufficiency.

Warning Signs of Heart Attack/Angina Pectoris

• Discomfort, pain, tightness, pinching or burning sensation, usually behind the breastbone
• Sometimes radiating over the entire chest, occasionally into the shoulders, arms, lower jaw, neck, back, or upper abdomen.
• Typical occurrence of the symptoms during physical exertion, excitement or after eating. The symptoms pass or subside within 2 to 15 minutes.

Interpret warning signals correctly

Unfortunately, delays also occur time and again because the patient does not recognize the alarm symptoms of a heart attack in time or considers them to be harmless. Typical warning signs or harbingers of a heart attack are: Discomfort and/or pain such as tightness, pinching or burning, usually behind the breastbone. Sometimes the pain radiates throughout the chest, especially the left, occasionally both shoulders, arms, neck to the jaw, back or upper abdomen. Typically, these symptoms occur with physical exertion, excitement, after a sumptuous meal, or when cold. If these symptoms last longer than 2 to 15 minutes or are even persistent, an acute heart attack is suspected and medical clarification or intervention must be sought immediately.

These symptoms are perceived differently depending on gender: Women are more likely to have atypical symptoms such as acute dyspnea, nausea, or weakness. Symptom recognition with subsequent delay in treatment is mainly shown by elderly and single patients with pain onset at home, at night or in the morning, and atypical symptoms. Interestingly, married individuals have the shortest alert times.

Attentive perception of physical symptoms, immediate, targeted further medical clarification and individual risk stratification lead to the best possible clarification and treatment of chest pain. Fortunately, only a few diseases with chest pain are dangerous, but these are not to be missed!

(Text source: patient magazine "Mittelpunkt")