heart pain

Heart failure and other things – blog 15, cats and chest pain (not linked)

Neema the cat left me a present of spider legs in the bath this morning. No sign of the body – she’d eaten that – just the folded up legs that washed down the plughole without catching, thankfully. Last night it was a mouse, not in the bath but deposited on its back on the lounge carpet while she rolled triumphantly on her side looking for praise at being so clever.

 

One glance told me it was a wood mouse, because they have distinctive tails of dark brown on top, white underneath. Most mice caught by cats are wood mice, usually native to the countryside rather than houses. I looked around for something to throw over it and remove it to the bin but the mouse rolled over, nose twitching. It looked around in a bewildered fashion and started to explore.

 

I saw the resurrection before the cat. Horrified at the thought of losing the mouse under furniture, I acted. Neema tried to grab it but I got there faster, scooping up the brown furry body and heading for the front door. It was warm in my hand. I deposited it gently among autumn leaves and weeds in next door’s patch, hoping it would recover before any other cats sniffed it out. Back in the house Neema was distraught. Where had her prize gone? She didn’t associate its escape with me, searching the lounge instead. Finally, with a disgruntled air she left for the back garden as if resigned to a fresh hunt.

 

On to the health subjects. The other night I was drifting off when chest pain woke me up again. I lay in bed doing my mental checklist. Is the pain central? Yes. Is it going to the inside of my left arm? Yes. Is it going up into my jaw line? Yes. Is my breathing affected? No. I’m not sweating, feeling sick or faint or dizzy, either. So as far as I’m concerned, it’s unlikely to be coming from the heart. The final test is to take two teaspoons of Gaviscon antacid medicine, which soothes the stomach and oesophagus (throat). Instant relief, so it’s likely to be stomach-related.

 

The reason for mentioning this is because so many people with heart problems, and those experiencing chest pains for the first time, are faced with the same dilemma: is this a heart attack or something else? Even when people call out the paramedics and they do their checks on respiration, heart rate and electrocardiogram (ECG), they don’t always know, either. At the moment the advice is ‘better safe than sorry’ and most people are taken to hospital for blood tests and X-rays or other follow-up procedures to determine whether the pain is coming from the heart, or if a heart attack has taken place.

 

The biggest problem is that pain coming from the stomach or oesophagus can mimic heart pain in position and type. The vagus nerve supplies most of the organs in the central part of the body so when it sends a sensory message of pain to the brain, it’s often not immediately clear where that originates unless there are other factors present to clarify it. From my own experience I’ve had all the typical heart pain signs we are told to watch out for – sharp pains shooting down the inside of the left arm (and sometimes the right) or up under the jaw as well as pain the middle of the chest, and none of it has been heart-related. Problems breathing can also be produced by panic and stress, adding to the overall confusion.

 

If this were an isolated event, the cause might be clearer, but in my case it isn’t isolated. I have been asked, on more than one occasion, ‘If you were getting chest pains, why didn’t you call an ambulance?’ My answer is that if I called out an ambulance to every episode of chest pain, it would be two or three times per week. (That has changed since I’ve been on ranitidine tablets, which cut down stomach acid, and the frequency of pain has subsided greatly.) I had chest pain several times while in hospital, but because I was already hooked up to a heart monitor and could be given a more detailed ECG within minutes, it was determined, each time, that the pain was not heart-related.

 

There is another type of chest trouble that can produce centralised shooting pains – from the intercostal muscles, the small muscles between the ribs attached to either side of the sternum, the breastbone. Some people probably recall having chest pain after doing something like gardening or any activity which puts strain on the chest area. Sometimes I can press lightly either side of the sternum and produce the sharp pain I’ve been getting, so I know I can rule that out. On its own, pain from that area can feel like the possible onset of a heart attack.

 

I’m not advocating that my personal checklist is something that other people should follow. It’s ALWAYS better, if there is an element of doubt, to call paramedics to check it out and go to hospital if necessary, especially if someone hasn’t experienced this type of pain before. All I’m saying is that there is often mimicry involved which makes it hard to determine exactly what’s going on, in those first few minutes. Just as stomach or oesophagus pain can mimic heart pain, the opposite can be true. Many people have thought their heart attack was indigestion.

 

I think it’s a question of knowing your body if the events are repeated frequently, as in my case. I hope that if it ever came to it, I would know if it felt different – for example, accompanied by difficulty breathing, sweating, dizziness or feeling faint – to know that it’s time to call somebody on an emergency basis. As a last resort, the CRT-D implant I have would shock my heart if necessary, should I fail to discriminate between different types of pain and have a cardiac arrest. Until then, I’m not going to panic at every twinge, unless my checklist throws up a different answer.

 

Researchers are perfecting a test that should become available soon, which will show whether or not a person has truly had a heart attack. See the link below:

http://www.bbc.co.uk/news/health-41399159

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