Dear Alice,

Heart attack or not; that is the question?

Hope for guidance. Last July, I was taken to the emergency room with all the symptoms of a heart attack. Doctors ran all kinds of test, and there was nothing wrong with me. This happens to be the third time I am being rushed to the emergency room for the same reason. Last Christmas, while my husband and I were opening the presents for the family, I got extremely dizzy, my chest began to hurt, my arm got numb, I was shaking, sweating, and I was having problems breathing, and there have been times in which either the left or right side of my head gets numb. Needless to say, according to the test results, there was nothing wrong with me. I am very concerned about these episodes, and greatly concerned with the results. Panic attacks had been ruled out, and I am not acting this out to get attention. Emotionally and psychologically, I am well balanced; apart from the ups and downs of the days of my menstrual period, I am normally quite balanced. And no, these episodes had never been around those days.

I truly hope that you may have some suggestions about these symptoms; I am open to any helpful suggestion you may be able to provide me. Your answer will be greatly appreciated. Thank you, and God bless you.

Dear Reader,

What a scary situation you’ve been through, especially since your health care providers haven’t been able to explain what’s been causing these troubling episodes. To answer your question — it’s unclear if you had a heart attack, as the symptoms you describe may signal a variety mild to severe conditions (outlined in more detail later on). However, it’s worth noting that people assigned female at birth experience different heart attack symptoms than those assigned male at birth, often leaving them to go undiagnosed for a longer period of time. With all this in mind, it’s crucial that you continue to seek immediate medical care if you have sudden or intense chest pains in the future, as this could indicate a serious medical emergency.

Though chest pains may be commonly associated with heart attacks, they're also possible symptoms of the following conditions:

  • Sore muscles: Some chronic pain syndromes, such as fibromyalgia, have symptoms of persistent muscle-related chest pain which may feel very similar to a heart attack.
  • Gastroesophageal reflux disease (GERD): This is the most common cause of non-cardiac chest pain, where its associated heartburn (burning chest pain) might be mistaken for a heart attack. Other symptoms may include pain radiating to the back, neck, arms, and jaw — all of which can be feel similar to cardiac related chest pain.
  • Panic attacks: As you've mentioned, panic attacks and heart attacks share similar if not identical symptoms, including chest pains, rapid heart rate, dizziness, and shortness of breath.
  • Stress cardiomyopathy (or “broken heart syndrome”): Unlike the average heart attack, stress cardiomyopathy is less severe and doesn’t involve blocked blood vessels or ruptured plaques. It’s typically caused by sudden and severe emotional or physical distress. Some symptoms include chest pains, shortness of breath, sweating, and dizziness.
  • Angina: This chest pain may arise if your heart doesn’t get sufficient oxygen, and might indicate underlying coronary heart disease. Other symptoms include sweating, dizziness, and shortness of breath.
  • Pulmonary hypertension: This is high blood pressure in your lungs, which strains the right side of the heart. Some symptoms include chest pain, dizziness, and shortness of breath.

Since your experiences are causing you great concern, it may be helpful to see a trusted health care provider with whom you already have an established relationship. Within this setting, you may feel more comfortable explaining how alarmed you feel, divulging your health-related history, and inquiring more about steps you may make to prevent future episodes. If possible, you might even bring along someone who has witnessed your episodes, such as your husband, and ask them to provide another detailed description to your health care provider. Similarly, if you have the results from your emergency room visits, you can bring those along for your provider to review. If your current health care provider is unsure about the cause of these episodes, don't be afraid to seek another opinion, as a new perspective may be helpful in finding the cause.

Lastly, you were wise to consider if and how your menstrual cycle may be affecting your episodes, as fluctuating hormones around this time may put individuals at a higher risk for heart symptoms. In fact, while you're waiting for your appointment, it could be helpful to daily journal any symptoms you experience, foods and beverages (including alcohol) you consume on a daily basis, and any prescription or over-the-counter medications you take. With these added steps, your provider may find some common factor or trigger that might be affecting these episodes, and subsequently advise you on appropriate treatment or preventative options.

Here’s to hoping that you and your provider are quickly able to piece together this puzzle and provide you with a sense of relief!

Take care,

Alice!

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