Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, M.D.
5 January 2005

WHAT IS IT LIKE TO HAVE A HEART ATTACK?

            The gentleman was 54 years old.  He was a hard-driving contractor in charge of several construction sites.  He had come to Central South Dakota to go deer hunting.  He got up at 6:00 a.m. and joined his friends at a predetermined site to bag the big buck that they had watched for several weeks prior to opening day.

            But now as he was riding out to this site, he had a discomfort in the middle of his chest.  He described it as a heavy weight being in the middle of his chest.  The pain was described as constant and didn’t really seem to change much, no matter what position he sat in.  As he rode along, he noticed that he was slightly nauseated but figured that breakfast had just disagreed with him.  About the time that they reached their hunting, the pain had definitely gotten his attention.  It seemed to be getting worse and now he felt as if he was weak.  He was very warmly dressed and noticed that his clothes were moistening and that there was perspiration on his brow at the time when the temperature outside was only 22 degrees.  He got out of the car and joined his friends.  They remarked that “he didn’t look good”.  He said that he was slightly nauseated and as they were talking he went over to the side of the road and vomited breakfast.  Then he really felt bad.  He told his friends about the chest pain and they decided to bring him onto the hospital.  On arrival at the hospital, it was obvious that something bad was happening to this gentleman.  He was very pale.  He was sweating even though he had come in from the cold and was very weak.  A wheelchair was brought to the car to get him into the hospital.  It was now about an hour and a half from the time of the onset of his pain.

            He was started on oxygen and given Morphine to help with the pain problem that he had.  After about 10 minutes, he was feeling significantly better and wondered if it had all been a false alarm.  But then the pain seemed to fade back in again.  By this time an electrocardiogram had been done showing that he was indeed having a heart attack.  His blood pressure was somewhat low at that point.  He gave no history of having a bleeding problem.  In light of the clear diagnosis of a myocardial infarct (heart attack) and the absence of a bleeding problem, he was given the clot-melting medicine called Thrombolysin.  In about 30 minutes he stated that his pain had completely gone away and he was feeling fine.  Air ambulance was summoned at that point and he was transferred to a hospital where possible cardiac surgery or angioplasty could be carried out.  All of this occurred approximately six weeks ago and he is now back to work stating that he feels fine.

            During his brief stay in our hospital, he had lots of questions, as you might imagine.  He was hundreds of miles from home, planning on bringing a big buck home and instead he lost a bunch of bucks and a lot of time.  Not knowing the doctors or the medical facilities in a life- threatening situation can be substantially anxiety producing.

            He first wanted to know what was wrong.  It was explained that there are arteries that supply blood to the heart.  One of these had become stopped up with a blood clot and the heart muscle supplied by this artery no longer received the blood to do its work.  This heart muscle without blood began to die, which is what causes the pain.  It was explained to him that this really is a life-threatening situation as the abnormal electrical impulses from his damaged heart muscle can wreck the rhythm of the heart.  It was then explained to him that if the blood clots could be melted, the damage to his heart would be much less.  After a long discussion he agreed to proceed and, fortunately, he had a very favorable result.

            Lastly, he wanted to know why he had had the heart attack and why it would occur just when he was going to get that big buck.  It was explained that the artery to his heart had become slowly obstructed over years of time related to high blood pressure that he had never addressed, to his cigarette habit for which he had had for 30 years.  It was also seen that he was diabetic and he didn’t even know it.  He had not seen a doctor in the last 12 years.  He was just too busy.  I asked if he would let his construction equipment go without servicing for 12 years and he merely replied, “Point made”.

            As a closing note, he mentioned that he had experienced chest pain just like he had that morning for several months before his heart attack actually occurred.  But each time he would get the pain, it would seem to go away without the need for medical attention.  He did remember one time that the pain came on and lasted about a half hour when he had an argument with one of the individuals at the construction site.  He said he almost came to get attention at that time but because the pain went away, he felt that there was not a big problem.  This is a very common story for people that eventually have their heart attack.  They will frequently have small chest pains that will come and go for a month to two months before the actual heart attack occurs.  The event that sets off the actual heart attack is very frequently a big event, such as the opening day of deer season, when the person has more adrenalin in their blood than usual.  That adrenalin rush makes the heart work harder, which is o.k. for a person without coronary artery disease.  But if there are blocks in the coronary arteries that will not let more blood come to the heart when needed, the chest pain problems begin.  Adrenalin also makes the blood clot more quickly. Thus, big events or strong arguments are very trying situations and often will precipitate the heart attack.

            On the follow-up letter this gentleman sent me, he promised not to wait another 12 years before seeing his healthcare provider for a checkup.  Your local clinics and hospitals are well equipped to deal with a heart attack when it comes. They are even better equipped and spend much more time trying to prevent the heart attack from ever occurring.  In order for preventive measures to happen, you need to come to the clinic and be checked for high blood pressure, cholesterol, diabetes, and other health matters.  The gentleman above acknowledged that he met his high level deductible on his health insurance in the first hospital day.  In addition, he lost 6 weeks of work and several of the construction contracts that he had fell far behind.  He did acknowledge that it would have been much cheaper to take an hour or so to come to the clinic and take the steps to prevent the heart attack from ever coming.