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PubMedDate not supplied

Sometimes (what seems to be) a heart attack is (really) a pain in the neck.

A 31-year-old patient complained of severe crushing chest pain that radiated to his left arm and jaw. After admission to the hospital, tests revealed a normal electrocardiogram, normal treadmill, normal coronary arteriogram, and normal cardiac enzymes. However, the patient continued to have pain, which was relieved by sublingual and intravenous nitroglycerine. He was discharged from the hospital with a diagnosis of "musculoskeletal" chest pain, taking nonsteroidal anti-inflammatory drugs, muscle relaxants, and narcotics. Two weeks later, the patient returned with worsening symptoms. Cardiac work-up was again negative. Thoracic and cervical spine radiographs were ordered for possible discogenic pain. After abnormalities were found on cervical radiographs, magnetic resonance imaging (MRI) was ordered, and the patient was referred to an orthopedic surgeon. Further work-up revealed a herniated disk at C6-C7, with radicular pain. Surgery on the suspect disk totally relieved the patient's pain.

Adult↗
PubMed1997

Australian patients' delay in response to heart attack symptoms.

OBJECTIVES: To examine delay in seeking treatment among patients with an evolving acute myocardial infarction (MI), and to identify factors which contributed to this delay. DESIGN: Patient interview combined with medical record review. PARTICIPANTS AND SETTING: 317 patients with confirmed diagnosis of acute MI interviewed within 72 hours of admission to three hospitals. MAIN OUTCOME MEASURES: Delay from onset of symptoms to arrival at hospital, and cognitive, emotional, sociodemographic and clinical factors which contributed to increased prehospital delay. RESULTS: Median prehospital delay was 6.4 hours; 41% of patients delayed less than four hours, while 28% delayed less than two hours. Prehospital delay was increased in patients with fewer years of education (P = 0.001), lower income (P = 0.003) and transportation to the hospital by private car rather than ambulance (P = 0.02). Delay time was increased by several cognitive and emotional processes (P < 0.001), such as waiting to see if symptoms would go away, being too embarrassed to ask for assistance, and not recognising the importance of symptoms. Delay time was increased with heartburn, breathlessness or intermittent symptoms and decreased with sweating and dizziness (P < 0.05). Independent predictors of increased prehospital time (P < or = 0.01) were fewer than 10 years of education, not wanting to trouble anyone, failing to recognize the symptoms of delay, and the intermittent nature of symptoms. CONCLUSION: Over 50% of acute MI patients delay seeking treatment by six hours or more. Many factors related to cognitive and social processes that contribute to this delay may be remediable with appropriate patient and community education.

Educational Status↗
PubMed1999

Evaluating novel cardiovascular risk factors: can we better predict heart attacks?

Myocardial infarction often occurs among persons without traditional risk factors, and it has been hypothesized that assessment of "novel" markers may help identify persons who are prone to premature atherothrombosis. However, when considering the clinical utility of screening for any new marker for cardiovascular disease, physicians should consider whether there is a standardized and reproducible assay for the marker of interest; whether there is a consistent series of prospective epidemiologic studies indicating that baseline elevations of the novel marker predict future risk; and whether assessment of the novel marker adds to the predictive value of other plasma-based risk factors, specifically, the ratio of total cholesterol to high-density lipoprotein cholesterol. In this article, these criteria are used to evaluate five promising markers of cardiovascular risk: lipoprotein(a), total plasma homocysteine, fibrinolytic capacity, fibrinogen, and high-sensitivity C-reactive protein. Background is also provided to assist physicians in deciding whether one or more of these novel markers deserve clinical consideration in general outpatient settings.

Biomarkers↗