Cheney's Choice

When Dick Cheney felt those familiar chest pains early last Wednesday, he knew exactly what to do. Having already had three heart attacks, he headed straight for George Washington University Hospital and sought immediate medical attention. How many of us would react so promptly--or, heart specialists agree, so properly--to the chest pains that could be early signs of a heart attack? Time is muscle, doctors like to say; the longer you wait, the more heart muscle you can lose.

The trick with heart attacks is to know what to look for, and that's not always easy. Cheney experienced the classic chest pains called angina--usually described as a squeezing pain that starts in the center of the chest and can radiate to the shoulders, neck, arms or back. Angina is the body's way of telling you that your heart is being starved; the heart muscle is screaming for the oxygen-rich blood that's not getting through a blocked or constricted coronary artery.

But the body's message is not always so clear. You can have angina without necessarily having a heart attack, and you can have a heart attack without the chest pains of angina. Fully one-third of all heart-attack victims feel no muscle pain at all, according to a study published in the Journal of the American Heart Association last summer. Their most common symptom is extreme shortness of breath or difficulty in breathing. Other signs include nausea, profuse sweating, lightheadedness, fainting, palpitations or unexplained anxiety.

It's important to know that these signs aren't specific for a heart attack and may be caused by another condition. The classic case of mistaken identity is when a patient suffering from acute heartburn confuses a backflow of stomach acid with a developing cardiac arrest (although you should be wary of any "heartburn" that doesn't go away or gets worse as you walk around). Tension and injuries in the chest muscles can also be mistaken for angina.

But as anyone who has ever had a heart attack knows, it's best to err on the side of caution. You should stop whatever you are doing and call 911 (driving yourself to the hospital is not recommended). Avoid any physical exertion that could put more stress on your heart. If heart disease or angina has previously been diagnosed, you may have medications such as nitroglycerin on hand. A nitroglycerin tablet placed under the tongue can provide quick relief by opening narrowed coronary arteries as well as other blood vessels throughout the body. Many doctors instruct patients to chew an aspirin, which thins the blood and helps prevent the clotting that can lead to a heart attack or stroke.

When you get to the emergency room, don't be afraid to say you may be having a heart attack, because faster access to lifesaving treatments--clot-busting drugs, emergency angioplasty, beta-blockers--increases your chances of survival. We've all learned a lot about the Electoral College in this presidential election, but the most important lesson may be the one Dick Cheney taught us about paying attention to even the smallest chest pains.

Dr. Ian appears on WNBC-TV in New York. E-mail: ianmedical@aol.com . For more on heart attacks, visit www.americanheart.org