Howard LeWine, M.D.

New test may speed detection of heart attacks

A heart attack (more formally known as myocardial infarction) isn’t always an instantly recognizable event. Severe chest pain often has nothing to do with the heart or blood vessels. Some heart attacks are so small they pass almost unnoticed, written off as indigestion or the flu. Others are major catastrophes, causing death or long-lasting disability.

A new blood test may help speed the diagnosis. This is important, because the sooner a heart attack is diagnosed, the sooner treatment can begin. The sooner treatment begins, the more heart muscle can be saved.

Fifty years ago, doctors had to rely on a person’s symptoms and sometimes hard-to-interpret changes on an electrocardiogram to determine if a heart attack was under way. Today, blood tests are available that can detect the chemical signature of dying heart cells. The blood test preferred today is called troponin. Troponin is a protein complex found almost exclusively in heart and skeletal muscle cells. Its sudden release into the bloodstream signals damage to the heart muscle. Combining troponin results with characteristic changes on the electrocardiogram and symptoms is currently the gold standard for identifying myocardial infarction.

Within the first few hours of a heart attack, though, both the troponin level and the electrocardiogram can be normal. That means people with results in the gray zone are observed and monitored for 12 to 16 hours with more troponin tests and electrocardiograms.

The new high-sensitivity cardiac troponin T test can detect smaller amounts of troponin in the bloodstream. This could let doctors identify small heart attacks that would otherwise go undiagnosed, or identify heart attacks earlier—and begin treatment earlier. Results of a study of the test, published online this week in the Archives of Internal Medicine, showed that it helped emergency room doctors rule out heart attack in just a couple hours.

Skip the home diagnosis

While it is important for doctors to quickly tell the difference between a heart attack and something else, like pancreatitis or a panic attack, it’s even more important for people with chest pain to get to the hospital as soon as possible, and not try to make a diagnosis themselves. Far too many people delay calling 911 or going to the hospital, and by the time they do a substantial section of heart muscle has died.

When it comes to chest pain, it’s better to be safe than sorry. (For more information on chest pain and heart attacks, I recommend that you read this article from the Harvard Heart Letter.) Keep in mind that chest pain is only one of the possible signs of an impending heart attack. Call 911 or your local emergency number right away if you have:

  • Uncomfortable pressure, squeezing, fullness, burning, tightness or pain in the center of the chest
  • Pain, numbness, pinching, prickling or other uncomfortable sensations in one or both arms, the back, neck, jaw or stomach
  • Shortness of breath
  • Sudden nausea or vomiting
  • Lightheadedness or dizziness
  • Unusual fatigue, especially if accompanied with a great deal of sweating
  • Sudden heaviness, weakness or aching in one or both arms

Comments:

  1. sally mae

    A lot of people also think that jaw pain is also a sign of heart attack, but it can also just be TMJ.

  2. mike farmer

    This is very important information…….thanks

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  3. Peggy Lee

    Heart is the very important part of the body and we should take care of it. So try to eat the kind of foods which provide better efficiency to the heart.You all may know that there are lot of people who suffers from the heart problems only. So we have to eat such kind of diet which has low cholesterol. So we can reduce the chance of the heart attack.

  4. safir

    A newer blood test (designed to detect cardiac troponin) is both more sensitive and more specific for heart damage. Cardiac troponins are found only in the heart. Depending on the hospital, either bilgisayar troponin I or troponin T is measured; in general, both work equally well. Current guidelines recommend that several measurements be obtained over a period of 8 to 12 hours after admission. Because there is a lag from the onset of heart damage to appearance of troponin in the blood, serial monitoring is important to avoid missing a heart attack. Patients with elevated cardiac troponin blood levels have likely suffered heart damage and are at increased cardiac risk. A lack of troponin (or any of the other proteins mentioned above) does not demonstrate an absence of heart disease, only the absence of heart damage. Further testing is necessary after the blood testing to determine if the chest discomfort is a warning sign of a heart attack (see also the Cardiology Patient Page by Ornato and Hand. Warning signs of a heart attack. Circulation. 2001;103:e124–125). This testing may occur in the hospital or in your doctor’s office.

  5. Anonymous

    I like the article and i am agree that heart is the most important part in our body.Every body wants to save or care of it in so many ways .But this article gives such a nice tip really.

  6. Michael

    Heart is a very important part of our body. Everybody try to save it. This is best post to save heart. This is a awesome tips for save heart.
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