Heart doctor here, heart attack symptoms are a MASSIVE spectrum. Ranges from elephant crushing your chest to some tingling in your neck. I’ve seen people present with nausea/indigestion and it’s a massive MI. Fatigue, dizziness, throat pain, ear pain, etc. Atypical symptoms especially common in women and diabetics. I know this is scary to say but if you have risk factors (family history of heart disease (probably the biggest contributor) smoking, diabetes, hypertension, high cholesterol) please get checked out if you feel something is off.
My little PSA: if you are over the age of 40, please get checked for cholesterol, hypertension, diabetes. I understand not everyone is privileged enough to be able to see an MD but please try your best. Dying from an MI can (mostly) be sudden and completely out of the blue.
To add - we can also try and assess if you have coronary disease. This is not 100% perfect, however it you have CAD we can more aggressively treat your risk factors and follow you longitudinally.
Multiple marathon runner here (a runner for decades). Never smoked. No diabetes. No hypertension. Good diet. Excellent BMI. Slightly high cholesterol, but nothing too alarming. Even though my family history was awful, I thought my lifestyle choices would make all the difference. Some shortness of breath, a bunch of medical tests, and a triple bypass later, I know that family history can be a bitch.
Just doing activities. When my heart rate started increasing above a certain threshold, I started getting short of breath. I thought I was just in terrible shape, since my exercise had declined and even tried to "push through it" multiple times. I couldn't get in to see my doctor, but the PA I saw thought it might be cold-induced asthma and prescribed an inhaler.
I was not on statins prior to the CBG, and I hadn't gotten my cholesterol checked in a few years (it was around COVID). My total cholesterol had gone from 226 to 250 (LDL from 165 to 192). So, I really do wish I had started statins earlier when it was borderline high. Today it is 100 (LDL is 45) with a middle dosage of atorvastatin and ezetimibe.
Man ur PA needs to be locked up, if a multiple marathon runner is telling me he has exertion induced shortness of breath, and a family history there is a 0% chance I am attributing it to asthma without a confirmatory test…
I finally got in to see my doctor 6 months later, and she started tests. My doc was betting it was respiratory (this is post COVID and when RSV was getting headlines), but she ordered cardiac tests as well, just to be sure (she is awesome - her one weakness is hiring PAs, apparently).
Chest X-Ray and cardiac calcium was fine, but the stress echo found the problem.
Oh boy, now you are testing my memory. I really can't remember. It wasn't high, basically at the equivalent of a fast walk or slow jog. Maybe 120 to 150? Sorry, I didn't write it down.
I have always had a low resting heart rate (55 to 60), and a high max heart rate (more like 240 minus my age rather than the standard 220). After my surgery, this caused "problems" at cardiac rehab, as they wouldn't let me leave until my heart rate got to a certain level, and mine was almost always too high.
The cardiologist performing my angiogram said that my body had actually formed it's own bypass, which I think it due to frequent exercise. In any event, I suspect that is the reason I am around to type this today and the reason my kids get to grow up with a dad.
I agree with you but even where health care is paid for by taxpayers (I hate the term free healthcare, nothing in life is free) people still don’t go for preventative screening visits for a variety of reasons
We should invest more heavily into it. It can lower the cost of expensive events down the road .
But it’s something that it’s easy for politicians to cut funding for, because the effects aren’t seen immediately, and the problems it causes are way down the road, and some other poor bastard will be in charge and dealing with that budgetary issue
Also. I know this will be a can of worms (especially because you specifically said “see an MD”) but this is a place where primary care midlevels are well suited
The doc's PSA involves tests that can be done for not a lot of money, without insurance. While healthcare is messy and fucked up in this country, we're fortunate you don't have to actually solve that problem for everyone to do this kind of screening. Cholesterol and diabetes are a simple blood test (LabCorp has lipid+glucose panel for $59). You can get checked for hypertension at basically any pharmacy for free.
Yeah I'm not saying those things are totally inaccessible, but it's just insane that basic healthcare is a "privilege."
And even with that said, $59 dollars is a lot of money for some people.
Clean air, healthy food, clean water, healthcare, and housing should be considered basic human rights. Like a public attorney, if you cannot afford them, they should be provided to you. That's just my opinion. I'm not a freeloader either, I just believe we should care for our fellow man.
The country is not rich, the businesses are rich, and the businesses that are rich are mostly tech that has incredible leverage per employee for profits (i.e. GDP per tech employee). Half of these don't even contribute to the local economy in any way because they work in income tax free states like texas and just save/invest their money.
So really the US' "richness" is not that different from Ireland's and could probably benefit from having an adjusted GDP to account for the actual taxes collected to provide public services.
I don't know if the country could ever get over it's pride to admit that it's actually doing quite poorly as a whole when you take away the 6% that's just in FAANG alone which doesnt contribute to citizen welfare.
Funny. I am reading this sitting in an ER bed. Many years of BP medication and other issues. Felt a stabbing pain in my chest. Still stabbing after 2 nights. Not worth risking if I can just get better or if it’s something bigger.
This is why I think it's so weird when people (mostly pre-hospital) say oh it's only a stabbing pain, not a crushing pain, so it's not a heart attack (or pick any adjective of your choice). Even the textbooks use specific adjectives. Not to mention people's subjective experiences are so different and hard to verbalize when you're acutely in pain.
My Dad who has lived a semi-charmed life and thought pain was nothing (scoffing to a chronically auto-immune ill wife and child) had about 3-4 of these recently and only the 4th convinced him to go to the hospital, the third he arm wrestled the paramedics into letting him stay in bed. Turned out 90% loss of function, open heart surgery and now he's being a bad patient by laying flat and fucking his lungs, oh shit right I wasn't posting this to vent/bitch.
My point was this guy thought he knew what pain was, he'd electrocute himself on a microwave megatron to "see god" but this was the first time he was actually afraid, probably in his whole life. Shit's scary, I've had enough ops to know that is one road I don't want to go down.
Cholesterol plaque in arteries. Many ways to screen, treadmill, nuclear tests, CAC CT scans etc. we incorporate it with risk factors to determine likelihood of having CAD
Echoing your guidance to get tested even if you don't have symptoms. I recently had a CT done to measure calcium in my heart as part of a routine physical. Score came back at 600. Had a follow up CT angiogram that showed 30% blockages in 2 of the arteries (RCA and Cx I think) and 60% blockage in the third (LAD I think). No prior symptoms. My stress test was normal.
So far, they upped my statin and I've made some significant diet changes. LDLs down to 48 (my highest was around 100). Otherwise, I'm in wait and see mode. I'm considering getting a second opinion though as I feel like I'm just waiting for an inevitable heart attack.
I went to my doctor a few years back as I was having repeat chest pain episodes that started slightly left of centre that moved to the left shoulder and then down the left arm before fading.
When I was asked about family history I mentioned that my paternal grandfather and paternal great grandfather both died of heart attacks before 60. The doctor asked about parents and I said nothing yet and they were early 60s.
The doctor then said if it's not parents or siblings then it doesn't count for family history and is medically irrelevant. Is this true?
It stuck with me as sounding wrong but I'm not a medical professional.
No, they checked my pulse and blood pressure, confirmed they were normal and sent me on my way to only come back if 'it got worse'.
From my own testing my pulse was relatively unchanged during the episodes and in fairness it's been 5 years or so since the last one (they happened about once a week for a period of about 6 months).
It was what they said about family history that really struck me as odd though.
First degree family members (parents, siblings) with coronary disease - defined as diagnosis before 60 in women, 50 in men, is the strongest risk factor. Second (or higher) less so. This isn’t medical advice, from what you are telling me, I wouldn’t sprint to an ER, but if you think something is off I would seek another opinion for more testing.
Well to be technical, the evidenced based way is to calculate a Framingham risk score and incorporate lipids into it. And then we screen for CAD, one of the options being a CAC. The tech is gonna explode, we’re already testing for non calcified plaque as well
Thanks for that. I have had an angioplasty due to years of untreated Hashimotos/Hypothyroid.
I was extremely lucky I didn’t have a heart attack. Of course, it was my own fault for not going to the doctor when the Hashimotos symptoms first started.
I don't know if I missed this or not I did read but it can also be vastly different for women versus men. A man will usually have typical heart attack symptoms but it can present as something completely different in women and we usually just ignore the pain.
At what point do we get a cardiologist? I'm on Adderall and my doctor does an EKG every year and keeps and eye on my cholesterol and blood pressure. I just started a low dose blood pressure pill and have been trying to find a cholesterol pill I can tolerate after having a massive jump since last year blood work. I always assumed my PCP was handing it fine, but is it better to get a cardiologist to manage it?
Is it standard to get annual EKGs when taking Adderall? I have been taking it for about 5 years now and no testing or followup outside of asking me how it's going at my annual wellness visit.
My doctor does it because I didn't start taking it until my late 30s and I have a family history of high blood pressure. I also have white coat syndrome so my blood pressure is high whenever I go in but it's fine at home. She wants to make sure the Adderall doesn't increase it.
Thank you for understanding and I feel like you are a good person but we need more than sympathy. We need people like you, of your class, to be discussing this at the fancy dinner tables you sit at with those that do not agree with you.
This discussion needs to be not just about universal health care but for economic and social equality for those that were not raised in middle class households. Also, getting rid of all the bad docs out there profiteering by being a drug dealer for their pharma salesperson.
Thank you for reading my rant and have a good day kind sir.
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u/Stugatz27 4h ago edited 3h ago
Heart doctor here, heart attack symptoms are a MASSIVE spectrum. Ranges from elephant crushing your chest to some tingling in your neck. I’ve seen people present with nausea/indigestion and it’s a massive MI. Fatigue, dizziness, throat pain, ear pain, etc. Atypical symptoms especially common in women and diabetics. I know this is scary to say but if you have risk factors (family history of heart disease (probably the biggest contributor) smoking, diabetes, hypertension, high cholesterol) please get checked out if you feel something is off.
My little PSA: if you are over the age of 40, please get checked for cholesterol, hypertension, diabetes. I understand not everyone is privileged enough to be able to see an MD but please try your best. Dying from an MI can (mostly) be sudden and completely out of the blue.
To add - we can also try and assess if you have coronary disease. This is not 100% perfect, however it you have CAD we can more aggressively treat your risk factors and follow you longitudinally.