Wish I had some deep insights to share as a result but right now all I can really say is
"If you start feeling chest pains, don't hesitate to call 911. If I'd waited much longer I probably wouldn't be here to send this. Learn the warning signs and call 911 if in doubt."
While it's definitely wise to call 911 when in doubt, it's good to have own understanding first so we don't ignore the symptoms AND don't flood 911 with false problems.
'Typical' signs do not present in everyone: in particular diabetics are at increased risk of having 'silent' heart attacks, And chest pain that is not typical may also be a heart attack.
An ECG can rapidly demonstrate that a patient is having a heart attack or as we call them myocardial infarcts, and excellent intervention is often possible.
If the above condition/pain is experienced and there is not a clear ECG picture of a heart attack troponin levels are taken at 6 hrs, an increase f which will demonstrate that there was cardiac specific muscle damage.
Without wanting to alarm anyone, there is in the US 250,000 sudden cardiac deaths a year, almost all from a coronary artery called the left main blocking: this vessel supplies a huge percentage of the heart muscle and when it blocks there is no warning and the heart doesn't have enough fuel to keep pumping.. These patients unfortunately almost all dead on arrival. There is very little that can be done to predict this as their first episode of chest pain usually results in death within minutes, and there are rarely indications that the patient is at risk of such a problem.
Edit: Apparently I'm wrong, I know nothing about ECG.
I therefore believe that a smart watch would not with any current technology be capable of detecting a heart attack.. Pulse and heart rate are simply not useful (neither sensitive or specific) criteria for detecting MI's
For further reading on the physics of an ECG hit up
http://en.m.wikipedia.org/wiki/Einthoven's_triangle
Edit: my ECG knowledge is a bit rusty- 2 points of contact is enough to produce a single waveform reading...
http://en.m.wikipedia.org/wiki/Straw_man
The important idea is that I'm not asking the wearable to tell someone that they're having a heart attack but simply indicate some one "test" is not within range.
Really the only thing I can think of is some sort of transcutaneous monitoring of troponin levels in the blood, but that's hard to do (without needles) and a late indicator... troponin levels don't start rising for a few hours after the damage has started.
Apparently I'm weird because I wanted to watch the angio. They kept telling me that they "didn't need my help" :)
I was saying "how often do you get to see your insides?"
If the area of infarct impacts a part of the heart responsible for electrical conduction, stuff like that can absolutely happen, but it's not especially common.
Any just to clarify further... you'd need two points of contact that complete an electrical circuit. You couldn't just wear another watch.
You _could_ wear two watches and have a small wire that you use to connect them together when you want to check, but that's only going to give you Lead I, which is one of the less useful leads (and it's completely useless in isolation).
If you really wanted to get crazy, a watch on your right wrist connected to an anklet on your left ankle would give you Lead II, which could at least get you a look at the inferior aspect of the heart (and therefore the RCA).
But I'm just getting silly now... If you think you're having a heart attack, call an ambulance. They'll do a full 12 (or 15) lead ECG right in your bedroom.
I have a statistical medical question. Is the problem that they're completely unrelated, or that interpersonal variation is larger than the typical impact?
Very long term data analysis with a sudden change might be much different than the experience of a ER doc seeing someone for the first time.
I guess the relevant data source would be someone hooked up to monitoring gear in the hospital when they have a second heart attack while onsite... it might not even be visually obvious but perhaps a detailed statistical analysis would show something before/after.
How can we monitor this effectively? There must be a solution that does something after something has registered a problem.
This often spirals into the terrible cycle of anxiety -> chest pains -> anxiety about the chest pains being a heart attack.
I can only assume that the chest pains will be different and more severe if I should ever have a heart attack.
In her case the deeper I delved into her personal life the more it became apparent that this was a clear cut case of stress/anxiety related pain- that was having physical manifestations.
for her, we discussed exactly what you are describing: that anxiety leads to the pain, which then leads to fear about it being a heart attack, which worsens it etc. we went through the work up we had planned and after her second troponin was negative we sent her home to have an outpatient stress test to see if she may have some partial blockages. If that is clear, we as medical personnel feel comfortable knowing that her episodes are non-cardiac in nature- and referral to psychologist for CBT (which she had previously undertaken to good effect) was recommended. I think she will do well, she appears willing to seek help.
I hope you are also seeking help for your anxiety, and that you have had at least one good work up for your chest pain to exclude a cardiac cause.
I execise regularly. If those device are effective, I would love to use them weekly or monthly on myself and collect the data long term for me and possibly my doctor.
For data collection or your own interest, a proper 12 lead ECG is a great reference item; but again if the machine is like [1] you are only going to get this simple trace that doesn't tell you much; even serial ECG's on a normal healthy patient (or even someone with moderate heart disease) will be almost perfectly normal day to day, month to month at rest.
So I would be inclined to suggest that it is a bit of a waste of money from any attempt at home diagnostics, however if you were concerned about your cardiovascular risk you should discuss it with your doctor.
[1] http://www.amazon.com/Medical-Real-Handheld-Portable-Monitor...
Is there such thing already?
Collect all 12 leads signal via bluetooth connection to a Iphone/Mobile device.
Whenever I do a 30,60 minutes exercise in the GYM, the system will collect all the data and store them in my personal cloud.
Whenever I did annual checkout with my PCP, I will go over the data/chart with him/her and see if there are any abnormalities that might trigger any concerns.
If they spot any potential issue, than we have more info to do proper stress tests in the hospital and lab setting.
Would this kind of device/process be valuable from your ( Doctor's ) point of view?
BTW, I have background in embedded system, cloud backend, and some mobile app, if any doctors think these kind of monitoring devices are useful. I can definitively love partner up working on such project. My mom suffered from heart attack a few years back - so this topic trigger a personal nerve for me.
EKG's have always been normal as has blood work when I did go to the ER. At my primary care doctor EKG's have also always been normal.
I have been in CBT and getting better but I have to say your post kinda opened a wound. The reason being my primary care doctor says I don't need a stress test and that the prior ones are good enough. She says given my age of 29 and risk factors there's just no reason for it. So far she's been right. Over the last 12 years the hundreds of times I have had chest pain I am not dead yet.
I guess now you have me a tad worried. My primary care doctor and her colleagues have been so convinced at times when I show up with chest pain they don't even think a EKG is necessary.
It certainly does sound that if you are known to a cardiologist. have previously had negative stress tests and have had recurrent episodes of the same type of pain with negative ECG's then you have been worked up appropriately to exclude a cardiac cause. Your primary care doctor knows you much better than I ever can over the internet so I defer to their more expert opinion and interpretation of your recurrent presentations. Take solace in the fact that previous investigations have shown the pain to be non-cardiac in origin.
That sounds like there was more than ample warning about the subject matter. If it's triggering, you might not want to seek it out?
This is mostly for men, right? I've read previously that the symptoms for women are quite different.
There's no guarantee you'll have any pain at all... Honestly, someone who is diaphoretic and nauseated is going to get an ECG, even if they don't have any complaint of chest pain.
Her experience was very, very different from what we're taught to expect from a heart attack as men. She'd been nauseous and tired, with some chest tightness and general malaise, for a period of about 4 days before my stepdad told her to go to urgent care, where they put her on an ambulance to the ER, where they admitted her to the cardiac ward. She had been having a heart attack for most of that four-day span and wrote her symptoms off as "just part of being a 66-year-old woman." The length of the event caused her to go into shock, and she's had all sorts of problems falling out from that. She's stable now, at least, and is recovering well, but she should've sought medical care much, much sooner.
Since this happened, I've spoken with dozens of men and women I know about heart attack symptoms, and so far only a couple of people knew how different the presentation was across genders. If you have any late(ish)-aged women in your life about whom you care, make sure they know what a heart attack might feel like for them. My mom got lucky and has had a great team of doctors working on her recovery, but you can't count on luck the way you can count on knowledge.
Luckily I recognized the signs and was very near a hospital ED. I wasn't in incredible pain, but I knew what was happening. I was actually driving and made the decision to get to the hospital instead of calling an ambulance, as the time would have been longer.
Got to ED, straight to a bed, then ECG and bloods taken, two hours later angiogram/plasty and now have a stent in the Circumflex artery and working on the other problems.
Fortunately it looks like the damage has been fairly minimal. Echo cardiogram shows mostly "normal", but getting a thallium test next week.
I'm T2 diabetic and had let my sugars get out of control.
Don't do that.
Now I'm doing the exercise and diet changes that I should have done a long time ago.
What were your readings at the time, if you don't mind?
By the way your heart doesn't feel pain itself no nerves for that, which is why there are all these other spots that get reported as uncomfortable or painful because the body "finds someplace else" to express the problem. The other sign is the shortness of breath and gasping...this must be simply because your body is responding to the heart not getting oxygen past the artery blockage (downstream)and is trying to get more oxygen. Note also when you get that second stent they are blocking an artery to insert it so you get a chance to experience the heart attack feeling as per shortness of breath if you missed it the first time.
I've resolved to undergo Angiography, symptoms or not, once I turn forty. Angiography is not cheap but it is way more cheaper considering the costs of stents (specifically the ones that dissolve are quite expensive). A day of preparation and an hour of discomfort is nothing at all considering the benefits.
Where are my darn nano-mites!?
Chest Pain The first and most obvious sign is chest pain. It may be radiating down your left side (jaw/arm). It is generally described as a crushing pain. This symptom is less likely to occur for women or people with diabetes. If the chest pain is not relieved by resting (i.e. sitting down), it points towards a heart attack.
Shortness of Breath As a body attempts to bring more oxygen into the body faster (because your heart isnt perfusing efficiently anymore), breathing will become faster and more shallow.
Pulse - Rapid, Weak You should take your pulse a few times a year to get a baseline of what it's normally like. During a heart attack, it can become faster and weaker. However, this is relative - your pulse may normally be weak. This is why it is important to have a baseline.
Nausea, Dizzyness, Sweating, Weakness These physical symptoms by themselves are usually not a concern (they happen with many sorts of illness really) but in combination with the above can be a warning sign.
In any discussion about heart attacks, it's important for you to understand the risk factors: http://www.mayoclinic.org/diseases-conditions/heart-attack/b...
If you're high risk and are suffering from the above symptoms, its always advisable to err on the side of caution and call the emergency services. In fact, if you're at all worried, just call.
There are some things you can do to help yourself during a heart attack: 1) Call emergency services. 2) Make sure emergency services can access you, especially if you're on your own. Unlock door, etc. 3) Half sitting position. Place your back up against a wall and sit with your knees raised. 4) Take an aspirin. This will thin your blood and relieve pressure on your heart. 5) Try control your breathing. 6) Try not to worry (yeah, I know, this is a hard one).
Source: EMT (Emergency Medical Technician) with voluntary ambulance services.
Strangely enough I'd just seen the poster that had all this on it the week before my attack when I was at the GP for a general checkup after a cold.
I later had a huge pain in my elbow. It was as if a big nail was hammered through it. I then went to my cardiologist and he noticed a change in my ECG. I did a ECG under effort and he stopped it after a minute. My ECG became completely crazy under effort. I saw it later. From this point things went as routine work. Got a stent and everything is now ok.
So symptoms my differ. I never had chest pain. Only elbow pain. The tooth pain was also a hint I now monitor. When it hurts I know I have to be careful with what I eat. It then calms down.
But if you have repeated episodes of chest pain relieved by resting, it might point to angina pectoris -- not technically a heart attack but potentially serious. If it's unpredictable pain and not relieved by rest, it could be unstable angina and much more serious. Yet another thing that makes heart trouble difficult to distinguish from anxiety.
My question is why can't we detect this high level of blockage much earlier (as in with a physical). Are the tests too intrusive or too expensive to recommend that the test(s) be performed periodically (eg maybe every 5 years after 30 or 40?)
Thanks!
The gold standard for detecting vessel blockage is angiogram- puncture the femoral or radial artery, feed a catheter to the top of the aorta and squirt some dye and then watch it on X-ray. This has risks however- risks of rupturing artery walls, causing bleeding and bruising, and can be expensive. So it is not routinely done: in fact it is only indicated if a patient presents with a MI (gold standard is to have the patient in angio lab within 90 minutes of onset of symptoms, which is great because if they are they can generally reverse the blockages with stenting before long term damage occurs), or if a patient has a positive stress test.
CT angiograms are becoming more common but still not commonly used due to decreased sensitivity.
If a patient is believed to have risk factors for artery disease then they may be given a exercise stress test- hook up to an ECG, get on a treadmill and if there are changes consistent with vessel ISCHAEMIA (as opposed to infarct), then an angiogram will usually be scheduled.
For patients too unwell for a exercise stress test nuclear medicine stress tests can be performed.
And finally in patients who have blockages in more than 3 arteries, the gold standard is still (for the time being) coronary artery bypass grafting.
I guess to summarise, the reason we can't detect it earlier is because generally we require invasive means to do so and invasive tests carry risk to the patient that are hard to justify for screening purposes. Perhaps in the future CT angio may be made more readily available, the scanners keep getting better and better and resolution increases all the time however you always want to minimise a persons radiation dose as for every 3-400 people scanned you can cause one instance of cancer... Something you must always be mindful of particularly in children
The interesting thing (aside from watching the angio, the technology is very cool), was that I'd previously had a minor infarct and didn't know it on a much smaller artery.
They found collaterals (I think the terminology is right) where the body "bypasses" the blocked artery.
Bizzarely this leads to situations where diabetics (who develop lesions all along their vessels, and thus have lots of areas of narrowing) can potentially be more protected from a sudden blockage compared to someone with an area of only one blockage - they have enough collateral circulation that the area of infarct is smaller with less damage resulting
No, not really, but hey, its worth clutching at straws...
I've never had shortness of breath while not active. That's also what the doctor told me to look out for. It's still scary and confusing though.
- Feeling diffusely sick, no specific pain, but a feeling that something was wrong.
- Oppression in the chest.
- Mild pain in the left arm
- Cold sweat.
I tried to drink some water, open a window to have fresh air, sit and relax, but after a couple of minutes nothing improved. I was at the office (alone) so I googled the symptoms of a heart attack and next thing I was calling 112 (Spain's equivalent to 911).
It was a mild heart attack, I got a procedure in the ambulance that stopped the attack, and a barely had heart damage. I had a triple bypass surgery a week after the attack, because the three main arteries were clogged. So it went well, because with those arteries I could have had a more serious attack at any moment.
My advice would be, if you are not feeling right and you never before had those symptoms, call 911 (or whatever the number is in your country). The people that picks up the phone are trained to assess the calls, and anyway it's better to raise a false alarm than to die.
That's also one of the terrible things about anxiety bringing on these types of symptoms, if you've already had a heart attack and subsequently you have an anxiety attack which brings on similar symptoms there is just no way to discount anything (for me). Also not fun.
Luckily the heart attacks I had weren't the result of an underlying problem with my heart, it was because I was going in to urine retention which caused either sodium or potassium to build up in my system causing all the problems. I can never remember which one it was!
But seriously, if you feel the symptoms get help.
Two days later i smoked another cigarette and the same feeling started again, but this time it felt like ants are running up my neck. After 5 minutes and calming down me teeth started to itch. From day to day i got more and more weaker. After 4 days i couldn't walk more then 25 meters without pain in my chest and short breathing. Thankfully one of my co-workers dad is a doctor and he said that he wants to take a look on me. After i arrived at his office i had to walk up 20 stairs and when i opened the door i've fall down on the floor.
Immediately two people took me to a room where they checked some stuff. My doctor made some tests and he said that it doesn't look like a heart attack but something is wrong with one of the lines on my ECG. He asked me if its ok to call the ambulance for doing more checks at the hospital. I said yes, please.
5 minutes later ambulance arrived and took me to the hospital. I was quite unsure if i should be happy or not as my doctor said it doesn't look like a heart attack. In the emergency room they took my blood to check if troponin is in my blood. The test was negative. I told them my history and the history of my dad who had his first heart attack with 36. I had 92 kg at 172cm. They made some other checks and everything said my heart seems to be normal, except one line on the ECK. The doctor said i have to stay for at least 1-2 days for additional tests.
First night, they check my blood pressure shortly before i slept. 180 / 130 @ 80 bpm. They gave me some stuff to get it down to a normal value. First morning, i woke up. I had pain in my chest so hard the i was close to fall out of the bed. Rolled left, rolled right. 2 minutes and 20 clicks on the emergency button later a nurse came into my room and gave me painkillers. 10 minutes later ECK + blood test. Everything negative except that one little line in the ECK. Two hours later i they made the first test. They brought me to the ultra sonic room were they took a look on my heart. 10 Minutes later they said, everything looks normal. One day later the next test. Cycling. I had to stop after 2 minutes and a pulse rate of 120bpm. The nurse asked me if i am serious that i cant ride more. They expected me to get up to 180bpm. The doctors got nervous, my blood tests are still negative, no troponin and the ECK is also negative, except one line. They decided to make a test called echocardiography. While watching my heart the gave me a medicament to speedup my heartbeat. When they hit 120bpm i started to sweat, at 130bpm they gave my emergency medicaments to calm me down. It took almost 30 minutes and 1 lorazepam to calm me down.
After that test they put me to the intensive care unit. For the first time they found troponin in my blood. I had 10+ cables all over my body. Every 4-5 hours they made blood tests, also when i slept. They gave me blood thinner and tranquilliser. After 4 days in intensive care unit they made a cardiac catheterization and they found a 99% closed vessel after 10 minutes. Another 10 minutes later i had my first stent. The complete process took around 45 minutes always with full consciousness. I felt horrible but i was so lucky that they found the problem. One day later the doctor told me what happened and what the future is. They said i can live a normal life without the risk of a heart attack but i have to change my life radically. So i did. One year later i am doing sports multiple times per week. I lost over 15kgs, never touched a cigarette again and i feel so much healthier now.
My doctor told me after everything was over that 3-4 weeks later i would be dead without help. My heart has no damage and only 2 little 30% spots are left. As long as i live a normal life and i don't want to run marathon i wont have problems in the future. The little strange ECK line is also normal now =)
I hope that my english didn't distract you at all, i want to show that even not normal signals of a heart attack can be a sign of much bigger problems coming up.
It is my experience that those who self-apologize for their "poor" English skills are the ones who have the least to apologize for. You have a better grasp of the English language than most college graduates in the United States.
That was a couple months ago. I think I'm going to go somewhere again. Maybe a psychiatrist, maybe a different doctor.
I'm the kind of person who just sits on things without really caring, and I probably do need to get this checked out.
Probably a selfish, personal comment, but I immediately searched for the word "troponin" in this thread and smiled to see it in the second post.
As an engineer having spent the last decade or so on an instrument that, among other analytes, measures the level of troponin in your blood (serum), it's quite satisfying to remember that my work is saving lives. Sure, you may not have been analyzed by one of our instruments, but somewhere a group of software, electrical, mechanical and biomedical engineers out there suffered through the miasma of FDA-required procedures, onerous development process, reviewing every line of code, arguments about exactly what a STAT reponse means, ridiculous training requirements, long validation procedures run by the most anal testers ever and ended up with an instrument that helped save your life.
It might not be as exciting as state of the art webapps, but it's nice to be reminded that we matter.
Yes, you do matter. People are better off thanks to you. Sincerely: congratulations, you're a lucky man.
Webapps are the technical equivalent of Richie Cunningham but biomedical engineering is The Fonz.
You are right on the money about calling 911. As men we tend to be slow making the call, and don't want to seem like whiners. I always think of the line from The Edge - "Most people in the wilderness, they die of shame".
Had emergency surgery for aortic dissection myself in february (mentioned it on caffeine thread here: https://news.ycombinator.com/item?id=8520241). I felt for a moment like someone grabbed my heart, then agonizing back pain took over, and some nausea. But no more chest pain. I really just assumed I hurt my back working out, because I do easily it once a season (though I'm getting older, but am acting younger)
I sort of ruled out heart issues because I did cpr in real life a few days earlier (I'm a fireman with FDNY (though now probably looking at forced retirement)). And took my CFR (EMS-lite) refresher a week before that. Thought it would be a total coincidence it's my heart.
Even though it takes time to heal, 8 months later I have mostly "healed from the healing process", and you will get there in time. In some weird way it is one of the best things to have happened to me too, kind of plants your feet on the ground in the way few things can.
The major post surgery things I had were:
- Chills waking me up at night
- Nerve damage from my shoulder being mis-positioned at some point
- The pericardium being partially removed during surgery lets me hear my heart much more intimately than I'd like to
But all these are way better now. Still have a lot of insomnia still.
Most firemen have a 2nd job, mine just is a little more cerebral than most (though there are doctors and lawyers on the job too).
Always loved having this split brain. The split aorta, not as much :).
I didn't find Rehab that bad, but then I was the youngest person there by about 30 years and a bit of a novelty. The drugs were the absolute pits though, I found that my reaction time dropped by about half a second. It took me about 2 months to be able to play squash again even after I regained by physical fitness.
They never found a root cause for my MI (there was no plaque , and they don't know why the clot formed). I still get asked if they know why it happened - like that's the most important thing. It's okay to not want to share any causes of your MI with everyone who asks. Apart from your medical professionals, they don't have a right to know.
Good luck and let me know if you ever need to talk.
Next phase was the month to a year as one ponders whether one managed to induce heart failure (enough damage not to pump blood in sufficient quantities) when faced with the tiredness any exertion including rehab seems to induce. The possibility of always being tired IS DEPRESSING. Also there is the "fun" of pains in the area one felt the heart attack pain bringing the question of "am I having another heart attack." And then there are all those stories about how great someone or other felt after having their arteries cleared as if one got a tune up...these stories are B.S. one is looking at about 6 months of not feeling great with any somewhat serious heart attack.
My overwhelming sentiment as the anesthetic set in before they cleared my Widow Maker and inserted a stent was, well, feeling pretty good and the notion there were "worse ways to die," and a certain willingness to go with it if this was it. So I guess I'm not much scared of dying once there.
Mentioning the heart attack is devilish fun in a gathering because most males start to squirm immediately.
There is a disconnect between one feeling fairly back to oneself and other's views of you who has had a heart attack(if they never had one). No one will learn from your example and stop smoking or eating less crap so don't even bother to think so. You'll be lucky if you manage to improve yourself your own bad habits.
After a while one resumes ones devil may care posture towards life with occasional reflective moments on when the 'next one' will be and if there will be a next one(probably).
So as far as great revelations? Not many mostly mundane discoveries. A stent is better than being filleted. Being alive appears better than dead to those of us that are still alive. And next time I feel a heart attack I WILL GET MY ASS TO AN EMERGENCY ROOM ASAP to reduce heart muscle damage that ensues the longer I wait.
I ended up in Accident and Emergency (UK) after developing what was thought to be a bad chest infection - I was coughing up bloody fluid from my lungs. After a some examination and an ECG, I was whisked into a ward and scheduled for a angiogram. A day or so later, right after the angiogram, I was told I had some damaged blood vessels around my heart and I had "probably" had "at least one" heart attack sometime in the past!
Every physician that did the rounds while I waited for a stent operation asked me whether I'd had any further chest or arm pains and I had to keep telling them that I'd never had any such pains - no 'classic' symptoms.
The upshot was that the heart damage was put down to a combination of diabetic-related complications, possibly not helped by one of the meds I had been taking.
3 years and 5 stents later (should have been 4, but one of the blood vessels tore during the procedure so I had to have an extra 'covered stent'!) and I am still up and about - albeit with some reduced heart function.
So, as robbiep commented - "'Typical' signs do not present in everyone: in particular diabetics are at increased risk of having 'silent' heart attacks"
Basically this is inflammation of the lining of your heart. the most common cause being idiopathic (ie. We don't know), or viral, followed by trama post-surgery or radiation therapy. Sometimes it has been caused by vaccination (influenza and others).
The symptoms make this tricky to diagnose, but if you have some combination of fever, consistent or spamming chest and/or upper back pain, difficulty lying down or adjusting position, lethargy, shortness of breath, change in unrine habits / color, go get checked out - an echocardiogram will often reveal the inflammation. High dose (500-625mg) aspirin helps. Most times it will resolve through such NSAIDs or with steroids.
Left too long this can lead to liver damage and can become a chronic constructive condition that mimics heart failure. This is generally curable by surgery to remove your pericardium.
In all seriousness, I hope you have a speedy recovery. Be thankful it happened in the RDU area. We have two of the best med schools in the country within a 30 minute drive of each other. I'm certain you'll pull out of this without a problem.
I kept insisting he get medical attention and he kept saying he was fine, in the end I said either you go get medical attention or I phone an ambulance.
So he goes to a local NHS walk-in center (I'm in the UK) where the first nurse who saw him phone an ambulance, daft macho sod was having a heart attack.
Saw him not long since, he'd gotten back into cycling, looked incredibly well and had dropped 3-4 stone (42-56lbs) having just completed a 300 mile charity ride.
Moral of the story, if you start getting chest pains radiating into your arms, sweating profusely get your ass to the hospital ASAP or phone an ambulance, early intervention greatly improves the outcome.
I've since learned not to panic when they happen and just live with the little shocks, but, you know, I'm only in my 20s, I can't help but wonder what my heart will do when I get to my 40s.
Needed a valve replaced too (no point installing pacemaker, then replacing the valve and having to re-install the pacemaker), so "don't die" stretched out to 11 days. After getting to watch a live X-ray of my heart, had open-heart surgery (which my boss wanted me to take as a vacation day), had an external pacemaker attached for 3 days (whatever happens, don't pull those wires out...hey, stop turning that "pulse rate" dial!!!), and then had the pacemaker installed. So now I'm a cyborg, with periodic data dumps and parameter tweaking, and looking at a the-hard-way battery change (whole unit upgrade while they're at it) next year. I couldn't sleep on my left side for two years because a wire was inductively stimulating my diaphragm when pressed close; eventually reprogrammed the wire's voltage/current to a tolerable state.
Feeling great, appreciate software which doesn't crash, and mechanical valve ticks like a clock.
As a bonus, the software monitors other things (while it's in there, may as well), and served to mitigate atrial flutter when that (unrelated problem) tried to shoot my heart rate to >350 beats per minute, pacer slamming on the brakes at 150bpm. ER crew was surprised when I walked in and calmly explained the problem. Glad that was in place to keep things together until the drive-thru heart surgery (run a blowtorch up an artery, zap 2 distorted nerves, go home) to fix that problem.
http://www.health.harvard.edu/fhg/updates/Surprise-of-palpit...
Taking some magnesium supplement could also reduce the symptoms, since a low magnesium level, caused by stress, can also lead to arrhythmia. Typically every time I am low on magnesium I experience eye twitches that are quickly disappearing after a few week of magnesium supplements. I am surprised it was not prescribed by your GP or cardiologist.
I don't really want to give medical advice carelessly but since you have seen a cardiologist the most serious cause have probably been taken into consideration.
The cardiologist didn't find it. He went to a neurologist, and that's who diagnosed him.
Your situation could be completely different, but I thought I'd share the experience just in case.
Have had the exact same thing on and off for the last 10 years or so (I'm 33 now). For the longest time, it would just be one flutter every few months or so, but recently it's gotten as high as a few times a day. Definitely seems to correlate with increased stress/sodium/caffeine.
My recommendation is to get checked out by your doctor and a cardiologist and trust what they say. Meaning, when they tell you everything is fine you should believe that.
I mainly experience PVCs (http://www.mayoclinic.org/diseases-conditions/premature-vent...). I probably experience those at least a handful of times per day. When I'm super stressed I can have them a dozen times per hour. The link I provided gives you common triggers and can help you reduce their frequency.
Is that correct?
But then again, it could very well be. Which is why you will never find a doctor who will say 'it's ok' from the history alone. They need a workup anyway... If there are no ECG or biochemical markers of heart attack and it responds to antacid in the emergency department then we can prescribe its use ongoing.
The other one that every medical student gets that convinced them that they are having a heart attack is muscular or rib pain, like which you describe. People present to hospital with it all the time but we usually quickly exclude it as a heart attack.
If you're concerned, always present.
The final straw for me to NOT act was that I had no radiating pain. No pain in face, jaw, arms, etc. I took an aspirin and went back to bed. The next day, I went to the doctor and the EKG looked fine.
The whole thing was stress-related. Two newborn twins in the NICU may do that to you. What was interesting to me was that these symptoms showed up several days after their birth and after any initial scares were over. By the time I had these stress pains, the babies were eating from bottles, gaining weight and were functioning as they should in room air.
The scary part to me was realizing that heart attacks aren't like they are on TV or the movies, where the pain is so intense that the person collapses. I'm very thankful that I didn't have a heart attack, but I learned a lot more about them from that stress spell.
Could you provide any information as to what could be the possible cause of your heart attack? Your age, habits etc?
I don't know what else you have going on in your life, but you are sacrificing the wrong thing. Forty-five minutes a day is nothing for the benefits you get.
After his heart attack he went in for an angioplasty with one of those nicotine patches on his arm. Since having a heart attack, he was trying to stop smoking. His doctor looked him in the eye and said, "Well here we are. Do you want to live or do you want to die?" My boss said he wanted to live. So the doctor ripped the patch off his arm and said, "Just stop with the nicotine then."
OP you have a similar choice before you. I'm now 42 and I see your LinkedIn picture and "a touch overweight" is not what comes to mind. If your BMI is not into the obese category, I'd wager you're close to it.
> Learn the warning signs and call 911 if in doubt.
One night I had pain and tightness in my chest. This isn't really anything new, because I have asthma and sometimes it feels like that. But then I noticed pain radiating from my chest down the inside of my arm. I realized that was one of the signs of a heart attack.
Got to the hospital just in time. Almost went into cardiac arrest in the ER. Lips were blue, heart rate began to plummet, etc.
It turns out it wasn't a heart attack, actually - it was peridcarditis, an inflammation of the lining around the heart. In severe cases (although this seems rare) it can swell so much that your heart can't pump effectively. You can die. I almost did.
Moral of the story doesn't change! Even if you're young and healthy, get to a hospital if you feel something in your chest.
Hope you recover fast, and yeah EXERCISE (if the doctor says so).
Related to the topic... I've had 'chest pains' of varying degrees for... 20+ years - chest pains alone aren't going to signal me to call, unless I feel they're different somehow from what I've had in the past. Someone else posted below that arm pains and sweating usually accompany this, so I'll have to look out for those - never had those, but have 'chest pain' often. And yes, have been to ER and had scans, and they can never find anything. :/
GET WELL.
Good luck on your recovery.
Make sure you go your an annual check up. Figure out how to get some exercise. And pay attention to the warning signs.
Worst part for me was the 8 hours waiting for troponin levels. Well and the angiogram/pasty/stent.
I had never used one, but when it came time for it, I just did it. It probably saved my life. My airway was closing up. I dialed 911 and injected while the phone was ringing. All is okay now.
Anyway, thanks for the PSA.
Thinking that I should have called my mom more often.
Not much fear, to be honest. I have a pretty stoic outlook by nature, and I was almost killed a few times as a firefighter. And as an atheist with no belief in any afterlife, I don't fear death too much.
When people say "start feeling chest pains" do you mean like WOW that really hurts, or hmm that doesn't feel right kind of pain.
It wasn't like on TV... guy clutching his arm and thrashing around... it was more like "damn, that hurts! Why does my arm hurt? Hmm, now my jaw... why am I in a sweat... goddamn, I better get to the ER..."
I was actually pretty calm. Drove there, parked carefully, walked up to the ER... as soon as I said "pain in my chest, left arm, jaw..." all the bureaucracy stopped and the medical stuff happened. Took about 5 minutes to be shaved for electrodes, aspirin given, ECG and bloods taken.
30 minutes later was admitted and was talking to the cardiologist about risk factors of angiograms...
2. Drink warm water with lime to stay healthy http://m.timesofindia.com/life-style/health-fitness/health/D...
[1] http://www.romanialibera.ro/societate/sanatate/doar-3--din-c...
1. http://scitech.blogs.cnn.com/2009/09/08/trapped-girls-update...
This isn't an exaggeration. Many people live paycheck to paycheck and can't afford the thousands of dollars a hospital trip would entail.
Also, wouldn't you "just" get treated, rack up a bill and then go to prison for non-payment - guess that might be worse than dying?
yes
>Also, wouldn't you "just" get treated, rack up a bill and then go to prison for non-payment - guess that might be worse than dying?
yes, but you don't go to prison. the only entity you can go to prison for not paying is the government. instead you will go through bankruptcy, in which all of your assets will be taken and your wages will be garnished for some period of time.
You will also absolutely get a bill, which could be quite large, and could be sent to collections, and could destroy your credit history.
While those last three aren't certain, they're common enough that they should give you pause to think...
When I asked for breakdowns of the debt itself, which I'm allowed to do under the FDCPA, I rarely got a breakdown of the total debt. One company responded to my request by serving me papers and filing a lawsuit. When I hired a lawyer to intervene and respond to the lawsuit, they dropped the lawsuit a couple of days before the date.
So the constant harassment, threats and stressors of being in over your head, is a kind of debtor's prison.
Well, have I got great news for you! There is this thing called the Fair Debt Collection Practices Act. Here it is:
http://www.ftc.gov/enforcement/rules/rulemaking-regulatory-r...
Want to stop calls to your work, at home, on your cell and even to your relatives and coworkers? Send them one registered letter telling them to stop calling you. Instantly gone. Why?
Because every single call they make to you about this debt after that one letter means they owe you $1,000 in statutory damages. When you sue them they even have to pay your attorney's fees so there are a million attorneys willing to take these cases for contingency!
Here's a quick write-up of what you can do for the harassment you described:
http://www.nolo.com/legal-encyclopedia/what-can-you-do-if-de...
Frankly, if you've been living in a "debtor's prison" like you've described, I'm assuming you haven't lifted a single finger to get out of it because this information is widely known in the U.S.
Check your political response reflex. It might be too hair-trigger.
A rephrasing might be "no, you won't go to prison, but will be made miserable via other methods."
Health insurance is ostensibly for this type of situation, but in reality if you're going to the hospital because "There's something wrong with me but nobody knows what," then the fear of insurance companies not covering it is very real. I don't know if they're legally allowed not to cover it in that scenario, but people have been screwed so often by insurance companies that the default decision making calculus is usually to assume the insurance company won't pay for anything.
This all assumes that you're someone with a relatively standard job and life. If you're lucky enough to have good health insurance and a fair amount of savings, then none of this applies, of course, since you can just get treatment in the same way as the parent commenter.
But the problem is that "feeling some pain in your chest" is a long way from knowing that death is certain. And if your habit is to avoid going to the doctor because you know the bills could ruin your life, then your default will be "I'm fine!" As the OP made clear, getting to the hospital quickly can be the difference between life and death.
I just did a quick Google search, and a reasonable estimate puts the number of deaths from not having insurance in the same ballpark as gun deaths or car deaths: http://www.pnhp.org/news/2008/january/make_that_22000_uni.ph...
Single guy detected. Nothing wrong with that, just saying. Its a balance, lifelong economic death penalty for the three of them, vs they get to hang around with me for a couple decades... in the homeless shelter.
And that's assuming treatment means a cure. Most of the time, especially when the Drs are "mystified", all treatment means is the survivors are much poorer.
Currently I have great insurance, although that'll end soon enough, making these kind of balance decisions interesting in the future.
> A reasonable person knowing that they would die without treatment would surely take the enormous debt.
But suppose your family is depending on you. If you die, they get a decent life insurance payment. If you live but rack up crippling debt, maybe they lose the house and the cars and now nobody can pay for the kids' education.
Choice gets a little murkier then.
On top of that you have interesting incentives that you get to think about with your doctor: are they recommending this treatment to make more money?
There are some great individual doctors and nurses, for sure, but our mean-spirited, psychotic medical/insurance system taps into this deep-seated fear that humans have of being abandoned. Abandonment is a more vicious fear than death, for most of us. Death (when it comes peacefully; granted, that's not as common as we'd like to believe) is either nonexistence or something that's probably very interesting.
To answer your question, you can go to the ER and get treatment without insurance, but that's not going to get you preventative heart surgery or cancer treatment. If you get cancer, you can't walk into an ER and demand chemo. For plenty of Americans with cancer, their first medical attention is when the fucking thing throws a clot or causes organ failure and it's past too late.
You won't go to prison for non-payment, but you will get a huge bill, because while insurance companies are good at negotiating medical bills, you can't. If you can't pay it (and U.S. medical bills can easily top $10,000 for a routine ER visit) then you can be taken to court, have a judgment against you, and end up with your credit destroyed (there's nothing on your credit report to say that the cause of your debt or bankruptcy is a black-swan medical event, or even medical at all) and your wages garnished.
It's not like these horror stories are common, but they certainly happen and most Americans know someone who's been involved in one. It's not like 25-year-olds dying on the street due to our bad medical system is a common event, but it is a terrible system that ruins lives on a fairly regular basis. The sword of Damocles hangs over all of us. Even with insurance, it's easy to get fucked. Michael Moore's Sicko (whatever you think of him, that documentary was incredibly well-researched and important) was about people who had insurance.
Weird. I had my first panic attack at 25, nearly 26. The medical folks thought I was having a heart attack at first, but the symptoms and tests didn't quite add up. Fortunately, I've been able to manage it reasonably well with the help of my GP, but I do occasionally have recurring episodes if I don't take care to avoid triggers (my fault, really, I'm bad about that sort of thing).
Oddly, reading this makes me feel better knowing that there's someone else who had the same thing happen in the same age range. What's funny is that you know in the back of your mind you're not a statistical outlier, but when you don't know anyone in your immediate circle who suffers from the malady, you can almost convince yourself there's something horribly wrong. ;)
I never did get the phantom smells, but it often expresses itself differently for different people.
Cheers, mate.
As many have pointed out, a person who chose to be taken to the hospital would be taken to the hospital and treated whether they could pay for it or not. The result of this would be a serious amount of debt, but likely could be paid down with a monthly payment. The worst case scenario is bankruptcy, which sucks (though it sucks much less if you're already poor and have no credit to destroy). Best case scenario, is that you make a lot of sacrifices, cope with making the monthly payments for many years, and eventually become debt free again. Like I said: best case scenario.
I think that anyone would agree, though, that either outcome is far better than dying young. (Also note that none of these scenarios includes going to prison for failure to pay your debts. There is no such thing in the U.S. legal system, except for certain debts owed to the U.S. government, and even this situation is rare and typically involves willful failure to pay, not mere inability. Private debts are just that: private.)
The real problem is that people in the U.S. are forced to make this sort of choice -- i.e., the choice between healthcare and basic material comfort. An ancillary problem is that people believe the myths that you're perpetuating -- if they think they won't be treated, or that they will go to jail if they don't pay, they may avoid treatment and die, essentially, only out of ignorance. This wouldn't be their fault. This would be the fault of a healthcare system that sends all the wrong signals, and secondarily the fault of the people who spread half truths about the healthcare system to score political points. (And I say this as an ObamaCare supporting, lifelong democrat.)
Or that people will usually forego seeking treatment because they can't afford to rack up huge bills? Again, not really an exaggeration. If you have a house that you live in with your spouse and child, then you need that house, and people will often make decisions with the best chance of preserving it. If you go bankrupt, you can lose your house except in some specific circumstances (http://www.nolo.com/legal-encyclopedia/lose-home-file-chapte...).
It's easy to forget, as programmers, that most people don't enjoy the same benefits we do. Most people are living paycheck to paycheck with little savings and children.
I do agree (as I said) that people should not be put in the situation of having to choose between preserving the lives they have built for themselves, and obtaining healthcare. But I think it's important to be scrupulously accurate and responsible on this topic since the discussion itself could influence somebody's decision not to seek treatment.
If you're marching around saying lives will be ruined if you seek treatment , then YOU, not some other person, are the problem.
Think carefully if the point you imagine you're making is worth that.
While it's true you may not lose your house (which I clearly articulated in my previous comment), there's more to life than a house. If you can't drive to work because you no longer have a car, then that's a huge problem. If you're putting your children through school, then suddenly you're jeopardizing their life by seeking to preserve your own unless the doctors know quickly and precisely what's wrong with you.
I don't understand why this is so controversial: People make suboptimal decisions, especially when the choices don't have clear outcomes. Here's some evidence that this actually happens in practice: https://news.ycombinator.com/item?id=8551522
If you choose to emphasize this extreme situation, as you did, then yes, you own some personal responsibility.
If you don't like that, then don't use extreme cases to make whatever point you want to make.
You're (by your own admission) using an extreme situation to make a point.
No, the situations aren't extreme. Like I said, people typically live paycheck to paycheck and can't afford trips to the hospital. The fact that someone on HN had direct evidence of this shows us how common the situation actually is. We should choose not to like that, and do something about it through voting.
> People make suboptimal decisions, especially when the choices don't have clear outcomes.
Is nuanced and, I think, correct. But your original comment didn't clearly say this (though now that I know your actual position, I'm able to read back and see what you meant). It sounded like you were saying -- like many other people -- that if you don't have insurance in the U.S. you can't get treatment, so you die.
Distinguishing between the two is important because to the extent that the latter view is perpetuated, it is a major reason why people "make suboptimal decisions."
I suspect that you and I have the same views about healthcare in America. I'm simply trying to get you to tighten up your somewhat loose talk about it. Things are bad, but you seem hell bent on making things sound even worse than they are. This impulse itself is harmful for precisely the reason that I and waterlesscloud have now both pointed out to you.
Case in point: did you know that there is also an automobile exemption in Chapter 7 bankruptcy that works similarly to the homestead exemption?
But lives are often ruined when people seek treatment, given that medical bills are the largest single cause of personal bankruptcy in the US. I don't think people get scared of seeking treatment because of the number of people pointing this out, as much as they get scared because of the number of bankruptcies.
So what about this is fiction? As the proud owner of a 1-million-dollar spinal cord injury treated within the US, I don't understand where the fiction starts. Also, I was insured.
(also, is 'largely fiction' synonymous with 'rarely'?)
"The risk of a head-on-collision during city driving is largely fictional." doesn't sound quite right.
Everyone has a threshold of what they consider serious enough to warrant a hospital visit. When you introduce massive expenses you shift that threshold upwards, which means missed diagnoses and an increase in avoidable deaths.
Also, often after treatment, hospitals will just write the treatment as a "loss" and get a tax break. I've had friends pay $20 for a broken arm fixed. The problem is that many will give sub-par treatment, won't do the surgery, etc.
American health care system is an atrocity.
It is also true that people sometimes get this calculation wrong and die as a result. This is due, as I mentioned, to a system that inhumanely forces this choice upon you, as well as people who spread misinformation about how our system works.
It's a serious problem.
I didn't know what to think, and still don't.
I suggest the same thing to folks with unmanageable student loan debts with no clear answer in sight.
I think it's unfair for society to have burdened such debts on people who didn't know any better, who weren't equipped with the resources or the knowledge to make the right decisions. What do you do? Be 'unfair to society right back, don't pay, get away, start over again somewhere else.
Pretty much. Though, compared with how corporations are fucking over little people left and right, it's hardly unwarranted.
This is not an unfamiliar story. There are people who did everything right, were kind and philanthropic their entire life, more than they should have been probably, but they find their whole lives suddenly ruined with just one accident. There are supposed to be certain trade-offs in a society, when one agreed to a social contract that they'll be nice to everyone, be law-abiding, pay their taxes which in part fund medical research, fund creation of roads and infrastructure that enable corporations to function and rake in money, etc., they expected for the system to be there for them in return when they had a time of sudden misfortune. If it's not there, I say fuck it, this is then time they also stop playing nice.
> I think that anyone would agree, though, that either outcome is far better than dying young.
Right, but how can you be sure? Doctors are clearly overly precautions because they don't want true negatives. In some cases (e.g. if you need to support kids) it may be reasonable to risk that.
If I had had lesser insurance and he had left me with a "it's probably fine", I might indeed be dead now as with the op.
The former, I agree, is a real problem (as I have now said repeatedly). The latter is generally a myth perpetuated by irresponsible people who want to score cheap points in the healthcare policy debate.
> The worst case scenario is bankruptcy, which sucks (though it sucks much less if you're already poor and have no credit to destroy).
Even though you immediately followed it with kind of a "but", I think you're seriously underestimating the effects of debt on someone in the U.S.
I have struggled financially for over a decade, after a period of doing really well. I could spend hours talking about the consequences of being poor (in U.S. terms).
1. Your housing options automatically become drastically limited. If you have bad credit, you don't get to pick and choose apartments or rental houses; you're more likely to end up in shared living arrangements or in the kind of apartment complexes that are willing to house people with bad credit, which also means your stuff is more likely to be stolen -- stuff that you can't afford to replace. (Having a load of laundry stolen was a hardship for me for about a year.)
2. Your employment options also become more limited. A lot of jobs, especially those that pay well, now do cursory background and credit checks as a proxy for judging whether or not you might try to rip them off. That of course makes it even harder to pay off your debt.
3. Forget about having reliable transportation. I've gone through 9 cars in less than 15 years: from one junker to the next. Used car prices are insane right now, so you're going to be stuck with someone's $500 or $1000 mechanic's special -- because that's all the cash you've managed to scrape together -- or you'll be doing a lot of walking and public transportation, neither of which are terribly convenient in most places in the U.S., which again limits your job options.
4. That beater you drive, if you drive one, becomes a target for law enforcement. They are most interested in cars that look like their registration may not be current, look like they may be a road hazard, look like they may be driven by a college kid with marijuana under the seat, look like they have a broken window ... the increased scrutiny is not only irritating, it can get expensive too, depending on just how poor you are.
5. Because your finances are limited by a lower-paying job, you're more likely to lack access to higher education, better quality food, or healthy hobbies.
6. You end up paying more for everything. You don't get to take advantage of discounts (for example, paying 12 months of insurance up-front), and if you do have any credit cards, you'll pay more on their rates.
7. If you don't have credit cards, every unexpected personal financial problem becomes a disaster. Oh, your radiator just blew a seam? Well, I guess you won't be driving anywhere for a while.
I'll stop there. Anyway, I don't completely disagree with you, but let's not just skip over the consequences of having a lot of debt. They can be really serious and long-term and dramatically change the quality of life someone has -- for the rest of their life.
The gentleman up-thread mentioned that when he went to visit his mother in ICU, he had to actively dodge the front desk person who wanted to discuss payment with him rather than letting him spend the last few minutes of his mother's life in her presence.
In the 90s, when I drove myself to the hospital suffering from appendicitis and I collapsed in the ambulance driveway trying to walk into the ER, since I was still lucid, albeit in pain, they felt it was more important to wheel me in to the billing booth and secure payment by taking all my available credit card information than to send me straight back to the examination room. They sounded quite pleasant and convincing that they were doing everything they could to get me seen right away, and they were very helpful in that they could just take the cards and write down the information after I was sent back, I just had to scrawl my signature on the release forms to get it started. It took me a decade to pay off that debt while avoiding bankruptcy and almost another decade to get my credit rating back up to a level that I could apply for some small bit of credit without fear of getting nasty looks from the person processing the application as a deadbeat.
While rationally, anyone would agree that either outcome is better than dying young, our society has become twisted in on itself in such a way that it is very easy to miss being rational when looking at the huge inconvenience and stress involved in incurring that cost versus the irrational hope that it is something small and it will pass on its own.
@mindcrime -- I am so happy to hear that you got fast treatment and that you seem to be doing alright. I hope that you bounce back quickly and that you are able to look back on this as a brief dip in an otherwise rich and rewarding life.
Yes, I would agree, most people do not go to the hospital in the USA unless they are 100% positive it is required. This prevents many early visits to the doctor. People will often wait until the very last moment to get help.
May your mother rest in peace. tears in my eyes
Should something be done to help that 16%? Yes, of course. Is it common? No.
[1] http://www.gallup.com/poll/168248/uninsured-rate-lowest-2008... [2] http://www.census.gov/content/dam/Census/library/publication...
Something that is true for 1 in every 6 people surely isn't a rare event.
http://www.reuters.com/article/2009/06/04/us-healthcare-bank...
This is reasoning backwards: you are starting with the conclusion you'd like to see (that bankruptcy is typical for people with health insurance), then trying to adapt the evidence to fit that conclusion. Let's try it the other way around, looking at the data first, and then drawing conclusions:
There were about 1 million non-business bankruptcies in the US in 2013[1]. Reuters says that 60% of them were caused by health bills, and of those, 75% had insurance. Taking the bankruptcy and the Reuters figures at face value, this gives us about (1m * 60%) = 600,000 bankruptcies due to medical bills in the US annually; and of those, (600k * 75%)=450k had health insurance.
Going by the earlier Census.gov figure that 16% of Americans are uninsured, and a US population of about 316 million[2], this means that about 265 million Americans have health insurance.
We can then calculate that of those American who have health insurance, only 0.17% (450k/265m) wind up in bankruptcy due to medical bills; in other words, 99.83% of Americans with health insurance do not wind up in bankruptcy.
I think we can thus safely say that it is definitely not typical for an American with health insurance to wind up in bankruptcy due to health bills. It does happen, but it's very rare.
[1] http://news.uscourts.gov/bankruptcy-filings-drop-12-percent-...
So if 600,000 medical bankruptcies a year happen, how does that compare to other yearly numbers? Well, there are about 4 million births a year in the USA, so someone being born in the USA happens only 7 times more often than someone becoming bankrupt through medical bills.
It may have been slightly inaccurate to use the word typical, however these figures seem to indicate that it is at least fairly common.
This is a good reminder for all of us with sedentary jobs to be active and get/stay healthy.
You care only when it serves your selfish interests.