By: Marci Lawing, RN – TriageLogic Learning Center Instructor
If life were like the movies, everyone having a heart attack would clutch their hand over their heart and complain of the proverbial crushing pain. Unfortunately, sometimes the symptoms of a heart attack can be rather subtle. There is even the rarely talked about “silent heart attack”. So how does one know when to seek medical attention?
Unexpected Heart Attack Symptoms
Women, in particular, frequently have less common symptoms that can be indicative of a heart attack. Symptoms such as a squeezing or fullness anywhere in the chest, not just on the left side. Sometimes the pain is not focused on the chest at all, rather it can be a pain in the arms, back, neck or jaw. This pain can wake one from a sound sleep.
So why do people delay seeking medical attention with the above symptoms? We all feel stressed out or tired at times and can often explain away these symptoms. We give excuses like “I was working hard in the yard today”, or “I haven’t been sleeping well due to work stress”, or “I ate too late last night and caused heartburn”. No one wants to think that the symptoms they are having could be a life altering heart condition that frequently needs surgery. Denial is a common first reaction.
Two Sample Case Studies:
Take for example Jean, a 37 year old female with no previous history of heart disease. She woke from sleep at 3AM with what she thought was heartburn even though she hadn’t eaten anything that may have caused it the evening before. She took antacids and tried to go back to sleep only to experience a sharp pain between her shoulder blades followed by extreme nausea. The next thing she remembers is waking up in the Emergency Room to be told she would need surgery to open her 100% blocked artery.
Other conditions such as heartburn, the flu or stomach ulcers can mimic heart attacks. Unusual sweating and fatigue are other symptoms that often go untreated. This happened to Sarah, a 45 year old female in good health. She was under a lot of stress at work and thought the burning pain in her stomach and chest was heartburn. She was more tired than usual and thought she was going through menopause because she seemed to sweat more than she used too. She treated her symptoms at home for several days before going to her physician who immediately did an EKG which showed classic changes associated with a Myocardial Infarction or Heart Attack.
Evaluating Patients for Possible Hearth Attach in Teletriage
What do you do if you are the triage nurse that takes a call from a nervous patient with vague symptoms such as upper abdominal fullness and fatigue?
- Rule One– Where is the pain? Any pain between the neck and naval is considered chest pain until proven otherwise! A good triage nurse will start coming up with “working diagnoses” from the second he/she starts talking with the patient.
- Rule Two – Consider related symptoms – “Multi-thinking” is essential to coming up with the right plan of treatment at the right time to assure your patient has the best outcome. The nurse may think “Epigastric fullness can be from a heartburn, gas, hiatal hernia, gastritis or a heart attack”. Fatigue, on the other hand, can be from stress, acute or chronic illnesses, or insomnia to name a few. Although they may not be related, she should always take a moment to think “could these symptoms be related?” She should always think of the most common reason for the symptoms, gas, to the most urgent, a heart attack.
How does the nurse tell the difference between simple heartburn and a heart attack? She doesn’t! Only blood tests, an EKG and a physician can make that determination. It is the nurse’s job to use her protocols, her critical thinking skills and her nursing knowledge to ask the right questions in order to make an educated decision about the safest disposition at that time for her patient.
Not everyone with these symptoms is experiencing a heart attack, but any unexplained symptoms should be evaluated by a physician.
TL Connect: What unusual symptoms have you evaluated that led you to suspect a heart attack?