Chest Pain

You are relaxing or doing some activity at home. Suddenly, you experience chest pain and shortness of breath. What is your immediate reaction? Dial 911 and call an ambulance? Get in your car and drive yourself to emergency department (ER)? Have a family member drive you to ER? Or pop some antacid pills in your mouth and wait?

Well, while you are scratching your head for an answer, let us ask the question to Dr. Hal Canham, ER Physician at Medicine Hat Regional Hospital (MHRH) and Medical Director of Medicine Hat Ambulance Service.

“As a physician, I may be able to judge if my chest pain is of cardiac (heart) or non-cardiac origin. If I am not sure, then I will dial 911 and ask for an ambulance. My advice to people in general is to call 911 immediately if they experience chest pain. There may not be time for self-diagnosis,” says Dr. Canham.

Each year, close to half a million people in Canada come to ER with chest pain. Some have acute life threatening illness. Others may have nothing seriously wrong with them. Some may have history of coronary heart disease. Others may not.

What about Medicine Hat?

In an 18 month period (June/97 to Dec/98), the ER Department at MHRH sees 53,548 patients. Out of these, 50 patients are confirmed to have heart attack and are eligible for thrombolytic (clot busting) therapy.

Dr. Canham studied these 50 cases. What did he find? “A major concern became apparent immediately. Of the 50 patients with diagnosis of heart attack, only 15 had called for an ambulance! This confirmed our impression that there is underutilization of the ambulance service for chest pain patients in our community.”

Why call an ambulance? Isn’t it faster for me to jump in my car and rush to ER?

If your chest pain is due to heart attack then the outcome of your illness may be dictated by: 1) the speed and mode of transportation to ER, 2) your previous history of cardiac problems, 3) rapid evaluation of your condition by ER physician, 4) the use of “clot busting” drugs in a timely fashion.

In 1997, the Medicine Hat Ambulance Service purchased new cardiac monitors and defibrillators. The aim is to speed up the delivery of “clot busting” drug to eligible cardiac patients.

Our paramedics are now able to do 12-lead cardiac monitoring in patient’s own home immediately on arrival. This test is transmitted “live” to ER physician to diagnose heart attack before the patient arrives. The ER physician is then ready with “clot busting” drug if the diagnoses are confirmed.

There is also another important reason to call 911. Early in the course of a heart attack, patients are at risk of having the heart stop (cardiac arrest). The chance of surviving this is better in an ambulance with paramedics at hand then in your own vehicle.

Dr. Canham, what is your message to the people of our region?

“The Medicine Hat Ambulance Service is truly an extension of our ER Department and rarely is this more apparent then when you are experiencing chest pain or shortness of breath. Be aware of symptoms suggestive of a heart attack and call 911 early!”

Pain is the most frequent presenting symptom. It is deep in the chest, described as “heavy”, “squeezing”, and “crushing”. The pain may radiate to the neck or the arms. There may be weakness, sweating, vomiting or giddiness. Symptoms may vary. So do not waste time on self-diagnoses. One telephone call may save your life!

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Coronary Heart Disease

A good heart is better than all the heads in the world. A healthy heart is, of course, better than all the sick ones!

But how many of us can claim to have a healthy heart?

Not too many!

Although over the past 30 years, death rate from coronary heart disease (CHD) has decreased by 50 percent, the number of people who have heart attacks has not declined. CHD remains the leading cause of death among adults. One of every 5 deaths is due to heart disease.

Our capacity to keep people alive after a heart attack has considerably improved, but heart disease can be very disabling.

How can we change this?

There are certain risk factors over which we have no control. You cannot change your age or genes. Changing sex may not prove worthwhile.

But there is hope! About 40 years ago, researchers recognized that high blood cholesterol level, high blood pressure, and cigarette smoking to be main risk factors for CHD. The good news is that these risk factors can be modified to improve our health.

In the last 7 years, the role of cholesterol in prevention of heart disease and heart attack is better understood and recognized. In most cases, cholesterol lowering diet is the first line of treatment.

If this fails then there are now newer and better drugs to treat this problem. Besides lowering cholesterol levels in the blood, the drugs also work on blood vessel wall and blood cells to reduce clot formation and narrowing. This results in better blood and oxygen flow to heart muscles.

High density lipoprotein (HDL) is good cholesterol. Low density lipoprotein (LDL) is bad cholesterol. And there is triglyceride. All three need to be modified.

When is the best time to have cholesterol level checked? Some experts suggest screening asymptomatic males in their 40s and females in their 50s. Your doctor is the best person to guide you through this. He knows your risk factors and decides at what age screening is justified.

The next modifiable risk factor is high blood pressure. The risk increases progressively with increasing blood pressure. And blood pressure increases with age. It is believed that after the age of 50, high blood pressure may be more dangerous than high cholesterol level.

About 20 percent of population have high blood pressure. Half of these people will have associated heart disease. The vast majority of people with high blood pressure go undetected or untreated. This is dangerous.

It is important that you have your blood pressure checked out by your doctor on a regular basis. He will be the best person to advise you on appropriate diet or medication if there is a problem.

The third important factor is cigarette smoking. Active and to some extent passive (second hand smoke) cigarette smoking is one of the most important modifying risk factors for CHD.

We are well aware of the fact that smoking is a habit hard to break. But Stanford University of California has a success rate of up to 70 percent among people who previously had a heart attack, says the Canadian Medical Association Journal.

A study done in Ontario and California shows that California has the lowest smoking rate in North America, in part because of the state government’s aggressive antitobacco campaigns. Only 19 percent of Californians smoke, compared to 31 percent of Ontarians.

The only way we can keep our heart healthy is to remind ourselves constantly that there are risk factors over which we have control. So have yourself checked out on a regular basis. Exercise atleast 5 times a week, eat healthy, and do not smoke. Having a good heart also helps!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!