Welcome to “Ask the Doc” – a new column by Dr. Kent Herbert.Dr. Herbert has been a physician since 2001. He opened his clinic, Falcon Family Medicine, in October, bringing the concept of “old fashioned values” to the practice of modern medicine.In his monthly column, Dr. Herbert will answer your questions related to health care matters. Simply submit your question to marylou@newfalconherald.com. It’s your chance to ask the doc.Check it out.Q: A friend of mine recently presented at the emergency room with severe chest pains and numbness in his left arm. He thought for certain he was having a heart attack. After many tests, the doctor told him he had a muscle strain in his chest. Is there one specific symptom that would present in the case of a heart attack alone?Dr. Herbert: Chest pain is one of the most concerning symptoms that a person can experience, and often the most difficult to interpret. This situation is not uncommon. In 50 percent of people who experience chest pain and are evaluated in the emergency department, the pain is due to something other than a heart attack.Other causes of chest pain can include muscle strains, acid reflux disease, lung disorders or panic attacks. In 15 percent of people, a cause is never found, but the serious causes are ruled out. When people go to their family doctor for chest pain, only about 15 percent are found to have heart disease, as the symptoms that trigger these visits are often less severe than those that lead to an ER visit.The classic symptoms of a heart attack are left-sided chest pain or pressure, shortness of breath, unexplained sweating, nausea and vomiting and often pain radiating to the left arm or chin. Unfortunately, most people having a heart attack do not experience the classic symptoms, but have some variation of them. No one symptom more accurately predicts a heart attack than another, and up to 25 percent of people who have a heart attack have no symptoms at all, or such slight symptoms that they aren’t recognized.Doctors are trained to think of any pain between the chin and belly button as possibly cardiac in origin. Therefore, if a person experiences severe chest pain, he or she needs to take it seriously and be evaluated by a doctor.Doctors follow a “rule-out” procedure when evaluating chest pain. We do cardiac testing first to rule out the heart as the cause of the pain before doing anything else. This testing can include a complete medical history and physical exam, an electrocardiogram (EKG), blood tests or an Exercise Treadmill Test (ETT). Sometimes, heart problems can be ruled out with only the history and physical or it may take other testing. If the symptoms are very concerning, a person may be kept in the hospital overnight for observation or may need a procedure like an angiogram (where dye is injected into the heart blood vessels to detect blockages). Sometimes, even after this, a heart attack is ruled out and the person is diagnosed with something else.Because the purpose of the emergency department is to diagnose and treat life-threatening and other serious illnesses, a patient may be discharged from the ER after a heart attack is ruled out but before a cause is found. In these cases, follow-up with the family doctor is important to further investigate the problem.The important issue with chest pain is not to try to diagnose yourself. If you experience new onset or severe chest pain, call 911 and get to the ER. If the symptoms are minor, intermittent, and you are not currently having chest pain, make an appointment with your doctor for evaluation. If you are unsure, call your doctor and discuss your symptoms. People are often embarrassed to go to the ER with chest pain only to find out later that their symptoms are due to a less serious issue. It is better to be cautious and to treat your symptoms seriously. Remember, while 50 percent of patients in the ER with chest pain do not have heart disease, the other 50 percent do.Clearly, we hope no one has to deal with these issues, so prevention is the key. To avoid heart problems, it is important to know your risk factors. Some risk factors you can’t do anything about, such as male gender and family history. Most, however, such as high blood pressure and high cholesterol, can be modified. The best way to avoid heart problems is to exercise regularly, keep your weight appropriate and don’t smoke. Also, it is important to know what your blood pressure is (it should be under 140/90), what your cholesterol is (it should be under 200), to be screened for diabetes and to have a regular physical examination. If your blood pressure or cholesterol is high, reduce them with lifestyle modifications or medications. Your doctor can do a risk assessment to determine how concerned you need to be regarding heart issues based on your specific risk factors.Kent S. Herbert, M.D.Board-Certified Family PhysicianFalcon Family Medicine7641 McLaughlin Rd.Falcon, CO 80831(719) 494-2006(719) 494-8448 faxwww.FalconFamilyMedicine.com
