Bill Clinton's Angioplasty and Stent Procedure (cont.)

If the EKG does not show an acute heart problem, the diagnostic challenge begins. Angina, the term used to describe pain from heart muscle that isn't getting enough oxygen, can present in a variety of ways. Sufferers may adamantly deny pain being present but instead complain of chest tightness or fullness, or a squeezing feeling. There may be indigestion and upper abdominal discomfort. The pain or ache may be in the arms or the jaw. There may be no pain or discomfort in some case but the so-called anginal equivalent might be the complaint of shortness of breath. The diagnosis of a potential heart problem begins with listening to the patient, asking probing questions, and looking for potential risk factors for heart disease.

Those risk factors include smoking, high blood pressure, high cholesterol, diabetes, and a family history of heart disease. Other questions might probe recent exercise intolerance or shortness of breath on exertion, which might be a clue that symptoms have been developing over time and have been ignored or not recognized by the patient. For Mr. Clinton, his risk factor for heart disease was 100%; he had coronary bypass surgery 6 years ago.

History is also helpful in accessing other potential causes of the chest pain, like pulmonary embolus (blood clot to the lung), dissecting aortic aneurysm (damage to the major blood vessel in the chest), pericarditis (inflammation of the sac lining of the heart), and reflux esophagitis (inflammation of the swallowing tube) among numerous others. Physical examination complements the history, but the gold is found in talking to the patient.

Medically Reviewed by a Doctor on 12/9/2014

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