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One problem with this is that, I, as an individual suffering from anxiety, "regularly" suffer form chest pains.

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.

http://www.calmclinic.com/anxiety/symptoms/chest-pain

Literally yesterday I treated a patient who has had 4 presentations this year to emergency with chest pain that sounds cardiac enough, except it lasts for several hours sometimes and sometimes she can 'feel it coming on' and heD it off by relaxing. Still, it could always be a heart attack and until a through work up is done to exclude it (acutely, ECG and troponins, as outpatient, stress test), it is worth investigating.

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.

Amazon has some home ECG monitor device. Do you recommend their use?

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.

the technology is very simple and very old so without knowing what sort of machines they are (if they are like [1] then they are more for monitoring abberant rhythms than detecting infarcts or ischaemia - it doesn't have enough leads to properly detect a heart attack) they may do an ok job; the real question is of benefit. There is little benefit to be obtained from regular ECG in an otherwise healthy person. You can't/shouldn't perform a home exercise stress test as you need to be in a hospital environment so that you could be resuscitated if things go badly.

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...

Let's say if we can get (build) a proper 12 lead ECG with proper home/protable 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.

Reading and ECG is not as easy as it sounds. Without training no a chance in hell it will mean anything to you unless your flat lining and then you won't be reading anything.

I suffer from anxiety and panic and have for years. Just reading this post and your post makes me anxious. The reason being I have seen a Cardiologist and had stress tests but years ago. 2 of them about 9-10 years ago after so many ER visits and then another about 5-6 years ago. All were fine.

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.

Hi there. I'm sorry it caused you worry to read what I had written. I was speaking largely in general terms - as I am sure you would be aware discussing medical situations, despite being medically trained, over the internet is not the best way to do things and I would hesitate to tell anyone that it is ok to sit at home and do nothing if they experience chest pain they are concerned about, it should be investigated at least once throughly.

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.

Wow, that's horrible, but I'm also upset you put it on robbiep. It's random advice on an internet thread titled "Just had a heart attack" under a comment "Can someone with some medical experience write about what are exactly the warning signs for a heart attack?".

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?

It could be a tense ribcage muscle. If you stretch and the pain changes then it's probably a muscle.

It is that at times. But sometimes not.

I suffered serious anxiety and panic for a couple of years. Called 911 several times, thinking it was a heart attack. My wife, who is a doctor, humored me through these episodes, though she knew what was going on. One day, as I came to her again and proclaimed I was having a heart attack, she said, "You know, if you're standing up, you're pink, and you're telling me you're having a heart attack, you're probably not (having one)." That calmed me down. Over the next year, I learned to "fix" my anxiety, and now only rarely feel a wave of panic coming on, and even then, can get it under control.

> The 'typical' signs of a heart attack are chest pain usually described as dull, heavy or tight, with radiation to the arm(s) and neck. The patient often also complains of diaphoresis (sweating) , shortness of breath and perhaps weakness.

This is mostly for men, right? I've read previously that the symptoms for women are quite different.

I'm glad you brought up the point about women, because I'm actually writing this from my mother's hospital room where she's been for about a month after a heart attack of her own.

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.

It's common for women to have pain in the center of their back (basically directly 'behind' their heart). Nausea is another reasonably common symptom for both men and women.

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.

As someone who had a heart attack exactly a month ago (100% block on LCx) I can say that I had pain that started in the arm, went up across my shoulder blades and pain in my jaw. Cold sweats as well. It happened over a period of about 15-20 minutes.

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.

> I'm T2 diabetic and had let my sugars get out of control.

What were your readings at the time, if you don't mind?

THe only sure fire way to check your heart is to have them pump some fluid in that allows them to see your heart and arteries pumping real time on a screen. A catheter operation in the cath lab. This can be expensive though I have heard there is a good deal in CHicago for a few hundred dollars. The rest, i.e., ECG is not a guarantee of diagnosis, I had several before my infarction as routine check ups and none revealed a 90 percent clogged LAD (Widow maker) and similarly clogged RCA and 50 percent clogged circumflex (which they didn't stent yet because stent cut off line is %70). Perhaps a stress test with the ECG is better. But taking a live camera look is the way to go if you really want to know, you can go in in the morning and be out by the afternoon if all goes well.

This procedure is called Angiography and I had this done for my dad after he was suffering with lack of stamina and heavy breathing even with mild exertion. The doctors found 5 blockages which wasn't surprising since he used to be a smoker and a foodie. Multiple stents were put (couple of blockages were so bad that the couple of wires used to make way for the stent bent and couldn't penetrate but thankfully they were not in the bigger arteries).

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.

I had no idea angiography could be an elective procedure with no symptoms present. Thanks for sharing, something to think about.

I agree, something to think about, but the very first hit on Google for "elective angiography" was an article discussing whether it is over-used due to the dangers including significant radiation. :/

Where are my darn nano-mites!?

I don't display heart attack symptoms well perhaps due to a high tolerance for pain. That said symptoms include some sort of pain, chest (elephant sitting on chest), jaw, in my case a feeling like a baseball pressing into the hollow of my left shoulder. When it started my very first thought was "I am having a heart attack." Which is to say when you have a heart attack its distinct enough from anything else you ever felt on your body you probably recognize it as a heart attack. So don't worry, you will know when you have a heart attack as long as you don't slide into immediate denial. Another sign of a heart attack pain is the pain gets worse and one squirms to try to get away from it (like a leg cramp setting in type squirm)so as it gets worse you will definitely ask to be taken to a hospital unless you are utterly insane. For me it wasn't what I connote as "pain" which has a sense of sharpness to it, it was more like a pressure in an area that was very uncomfortable.

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.

That's how my dad died. Mom found him on the couch with a bottle of pepto bismol next to him.

I'm sorry for your loss. My dad thought his heart attack was indigestion too. Ended up with a quintuple bypass and is still with us but it was really close.

Amazing response. Answered question, provided additional caveats, and even background information! Thank you, this was of interest to me and very helpful.

"... almost all from a coronary artery called the left main blocking...These patients unfortunately almost all dead on arrival."

How can we monitor this effectively? There must be a solution that does something after something has registered a problem.

This isn't as straightforward as you might think... Checking for occlusion of coronary arteries is a reasonably involved process.

https://en.wikipedia.org/wiki/Coronary_catheterization

Can you speak to women having atypical presentations? I did some reading after my mother had a MI and it seems fairly common for women to have longer, sustained nausea and discomfort vs. the classic male symptoms.

Could a smart watch detect a heart attack?

To take an ECG tracing you need at least 3 points of contact with skin around the body (a hospital ECG has 9 leads attached to the body from which the machine calculates 12 waveforms of electrical activity). A watch based mechanism would not have the capacity to do this and even a 3 lead ECG would not be considered sufficient as it would miss too many changes.

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...

> Edit: my ECG knowledge is a bit rusty- 2 points of contact is enough to produce a single waveform reading...

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.

How, about detecting one of the side effects of a heart attack? You can then evaluate if you have a problem by any of the other symptoms. If I'm experiencing chest pain and my smart watches is indicating that my heart rate is irregular, for example, maybe I shouldn't be ignoring this.

A heart attack isn't likely to cause an irregular heartbeat (at least not until well after the damage has been done). It's common for heart attacks to cause cardiac conduction anomalies called 'blocks', but these generally don't result in any irregularity of the pulse.

Yeah, I'm simply throwing out a strawman. I have no idea what's possible or important.

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.

Unfortunately, there aren't any tests that could be run at the wrist that would be even remotely specific for an MI.

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.

While I was waiting to go into the angiogram, I was feeling my pulse... it was weird, there was three beats, then a gap, or three regular beats and a fourth straight after the third... was fascinating to listen to...

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?"

Cool. That sounds like a pretty classic 2nd Degree Type 1 Atrioventricular Block (also know as a Wenckebach block).

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.

"Pulse and heart rate are simply not useful (neither sensitive or specific) criteria for detecting MI's"

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.

It would be neat if someday this could be built into clothing. Maybe not for the mainstream, but for people who are at high risk. Just a thought.

If it can accurately monitor your heart beats, then I believe it should be able to identify patterns that signal an impending heart attack. I'm not a doctor tho, so don't take me too seriously.

Edit: Apparently I'm wrong, I know nothing about ECG.

Honestly I'd go ahead and just strikethrough your entire comment. This is terrible advice.

What can you say about rapid heartbeat increase but no shortness of breath after walking up stairs?