• February 2011

Dr. John Maguire Helps Us Deal With Heart Pain

By Dr. John Maguire
Simplicity Urgent Care

Chest pain is one of the most common complaints we see in the emergency departments that I manage here in Northern Virginia. Typically, the patient looks up at me with big, scared eyes and asks, “Am I having a heart attack?”

I always wish that it were easier to tell, but despite medical advances, we are still usually unable to answer the question at the time of that initial visit.

Here’s why:

1. Chest pain is a very difficult symptom to pin a diagnosis to because it can be a sign of several other problems, including a broken rib, a blood clot, pneumonia, or a tear in the aorta, among other conditions.

2. That is why most physicians make a diagnosis based on the patient’s medical history. For instance, we know that if the patient smokes, has high cholesterol, and has a family history of heart disease, he or she is more likely to have a heart problem than the healthy triathlete.

3. Physicians are trained to create a differential diagnosis, which is a list of the possibilities that could be the cause of the symptoms. With chest pain as the presenting complaint, we care less about making a diagnosis; rather, we care about ruling out something that is life threatening.

Women and diabetics

There are two groups of patients that will commonly have unusual symptoms when they are actually having a heart attack:

Women: Heart disease is a big threat to women’s health. Believe it or not, statistics show that about 267,000 women die of heart attacks each year — six times more than those who die of breast cancer.

The reason it’s such a big threat is that women who are having a heart attack often have atypical complaints, such as shortness of breath, nausea and / or vomiting, and back or jaw pain. They also experience flu-like symptoms, fatigue, extreme weakness, light-headedness, and cold sweats.

In addition, women tend to be about 10 years older than men when they have a heart attack. About 82 percent are 55 or older. They also tend to have high blood pressure, high cholesterol, and / or diabetes (see more on that below). And they are likely to be smokers, overweight, and lead a sedentary lifestyle.

Unfortunately, women are often less likely than men to believe they’re having a heart attack, so they delay seeking emergency treatment. Obviously, this is a lethal combination and one that needs to be paid more attention to.

Diabetics: Another group of patients that have atypical complaints when they are having a heart attack is diabetics. In fact, if I had a nickel for every diabetic patient who is having a heart attack with no chest pain, but is complaining of significant nausea, I’d sure have a big pile of nickels.

That is why physicians must be masters of pattern recognition, and be able to see outside the “normal” patterns to minimize the possibility of missing the tough case.

Signs of a heart attack

Doctors agree that chest pain related to a heart attack, or other serious heart problems, is associated with one or more of the following:

  • Pressure, fullness, or tightness in your chest
  • Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and arms, especially your left arm
  • Pain that lasts more than a few minutes, goes away and comes back, or varies in intensity
  • Shortness of breath, sweating, dizziness, or nausea
  • Chest pain related to noncardiac problems

Chest pain that isn’t related to a heart problem is more often associated with:

  • A burning sensation behind your breastbone (sternum)
  • A sour taste or a sensation of food re-entering your mouth
  • Trouble swallowing
  • Pain that gets better or worse when you change your body position
  • Pain that intensifies when you breathe deeply or cough
  • Tenderness when you push on your chest

If you think you are having a heart attack:

1. Call 911 and the EMTs will take you to the nearest emergency department. While urgent care centers are great for a lot of things, the ED is where you want to be if you are having a heart attack. Please do not drive yourself to the hospital, unless you have no other choice, as your condition could worsen and you risk putting yourself and other drivers in danger.

2. Once at the ER or urgent care center, explain the problem and expect to be seen immediately.

3. In most cases, an EKG will be done quickly. This recording of the electrical activity in your heart is the first screen for heart attack. It also identifies patients that need to have other heart-related procedures done, including an angioplasty, where the clogged blood vessel is opened with a balloon.

4. Unfortunately, a relatively small percentage of patients have EKG changes when they are having a heart attack or angina. So an EKG is not always helpful. That is why doctors will also ask to draw blood to look for cardiac enzymes, which improves the possibility that we will quickly identify the problem.

Questions? Don’t hesitate to contact me at john.maguire@simplicityurgentcare.com.

About Dr. John Maguire

In addition to opening Simplicity Urgent Care in 2010, Dr. John Maguire is the medical director for three of INOVA’s freestanding emergency rooms in Northern Virginia where he is responsible for clinical operations and other administrative duties, and annually oversees more than 75,000 patient visits.

He has also served as operational medical director for the PHI Air Medical Group, AIR CARE, and helicopter transport services. A 1997 graduate of Georgetown University Medical School, Dr. Maguire graduated magna cum laude from Radford University with an undergraduate degree in Biology. He completed his residency in emergency medicine at Geisinger Medical Center in Danville, PA, and he became board-certified the following year, in 2001.

Dr. Maguire frequently lectures on medical topics, conducts peer reviews, and participates in research studies. His professional affiliations include American College of Emergency Physicians, American Academy of Emergency Medicine, Air Medical Physicians Association, National Association of EMS Physicians, the American Medical Association, and the Urgent Care Association of America.

About Simplicity Urgent Care

Simplicity Urgent Care is a neighborhood center that is open evenings and weekends, and never requires an appointment. Located at 3263 Columbia Pike in Arlington, the goal is to provide a medical center where you can see a doctor any day of the week — whether you have insurance or not. From treating sore throats and cold-and-flu symptoms to cuts and abrasions, strains and sprains, and urinary tract infections, the doctors on our staff provide fast, friendly care, as well as immunizations, X-rays, drug screenings, travel medicine, and more. As ER doctors who have specialized in pediatrics at some of the largest hospitals in the country, we have learned from our patients that the best way to provide good medical care is to keep things as simple possible for the patient. Making healthcare easier is our goal, and it applies to everything we do. For more information, visit www.simplicityurgentcare.com.