Heart Attack Archive

What makes you worry that chest pain is serious, like a heart attack

When is chest pain serious? That dull burning feeling in your chest doesn't seem to be going away, and even feels like it is getting worse. Is it a heart attack, or something else?

It's a vexing question, one that millions of people — and their doctors — face each year. What's the problem? Chest pain can stem from dozens of conditions besides heart attack, from pancreatitis to pneumonia or panic attack.

A study based on data from the Women's Health Initiative suggests that a high resting heart rate is an indicator of risk of heart attack in middle-aged women.

Q. After my heart attack, my doctor told me that damaged heart muscle cannot be replaced. If this is true, why am I walking on a treadmill five days a week? Is this helping repair the heart muscle damage or strengthen what's left of my heart muscle?

A. Your skeletal muscles can repair themselves after an injury — pull your calf muscle and, after a few days or so, it heals. Until recently, it was believed that the human heart didn't have this capacity. But the heart does have some ability to make new muscle and possibly repair itself. The rate of regeneration is so slow, though, that it can't fix the kind of damage caused by a heart attack. That's why the rapid healing that follows a heart attack creates scar tissue in place of working muscle tissue.

Clots that form in a leg or arm vein can be deadly; prevention is key.

Blood clots are lifesavers when they seal a cut. They can be dangerous, even deadly, when they form inside an artery or vein. A blood clot inside a coronary artery can trigger a heart attack; one inside an artery feeding the brain can set off a stroke. Inside a leg vein, a blood clot can cause deep-vein thrombosis. Never heard of it? You're in good company. In a survey conducted by the American Public Health Association, barely one-quarter of adults were aware of the disease, and even fewer were familiar with its signs and symptoms. That's a sad state of affairs for a circulatory disorder the U.S. Surgeon General and others say is a critical health problem that causes enormous health consequences and numerous deaths each year. To draw attention to this overlooked condition, the Surgeon General has issued a "Call to Action" on it.

Deep-vein thrombosis (DVT) is a clot that forms in a vein that runs deep inside a leg or arm. Pulmonary embolism (PE) is its most serious — and often deadly — complication. One or both strike upwards of 600,000 Americans a year, killing at least 100,000. That's as many deaths as caused by breast, prostate, and colon cancer combined. And one-third of the survivors are left with long-term health problems.

Depression that develops for the very first time during recuperation from a heart attack affects recovery more than depression that started before the attack.

Recovering from a heart attack is tough enough without facing the fog of depression. Yet that's exactly what happens to nearly half of heart attack survivors. Depression is a painful, isolating, joyless state of mind that interferes with recovery and dulls life. It may even make it shorter "" people with post-heart attack depression are two to three times more likely to have another heart attack or to die prematurely compared with survivors who don't have depression.

Surviving a heart attack is cause for celebration. It's also a trigger for depression. Up to half of heart attack survivors get the blues, and many go on to develop clinical depression.

Early experiences with antidepressants weren't that promising because older tricyclic drugs such as clomipramine and nortriptyline sometimes threw off heart rhythms and further endangered the heart. This made doctors leery about recommending antidepressants, even when selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), and Zoloft (sertraline), and others came along.

After a Heart Attack

Questions to Discuss with Your Doctor:

• Have you had chest pain or pressure since you were discharged from the hospital?
• How severe is it?
• How long does it last?
• Does it stay in your chest or radiate to other parts of your body?
• Did you have this pain before your heart attack? What brings it on? How frequently do you get it?
• What were you doing just prior to the chest pain?
• Do you ever get chest pain or pressure at rest?
• What relieves the chest pain?
• If you take nitroglycerin, how many doses do you usually need to take before the pain goes away?
• How often do you take nitroglycerin?
• Do you get short of breath when you lie down or exert yourself?
• Do you awaken in the middle of the night short of breath?
• Do your ankles swell?
• Do you ever feel lightheaded?
• Have you fainted?
• Do you get rapid or pounding heartbeat for no reason?
• Do you know what each of the medications you are taking does?
• Do you know the side effects of each medication?
• Are you having any side effects?
• Are you taking an aspirin every day?
• Are you doing everything you can to modify the risk factors that can worsen your coronary artery disease (cigarette smoking, high blood pressure, high cholesterol, and diabetes are the most important risk factors)?
• Are you participating in a supervised exercise program?
• Are you resuming your normal activities?
• Are you sexually active?
• Have you returned to work?
• Have you been feeling depressed since your heart attack?
• Have you been able to reduce the stress in your life?
• Have you been fatigued?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Pulses in your wrist, groin, and feet
• Listen over the major arteries in the neck, groin, and feet (for abnormal noises)
• Look at the veins in the neck to see if there is extra fluid in your body
• Heart and lungs
• Ankles and legs (for swelling)

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests for glucose, lipid panel (cholesterol levels) and C-reactive protein (CRP)
• Electrocardiogram
• Echocardiogram
• Exercise stress test