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.
If the patient continues to have pain at rest, and the working diagnosis is that pain is coming from the heart, the goal is to resolve the pain quickly and try to protect the heart muscle from damage while the diagnosis is confirmed. Aspirin is given to make platelets less sticky and prevent blood clots form occurring in the narrowed coronary artery. Nitroglycerin is given by tablet under the tongue, by paste on the chest, or intravenously to dilate the coronary arteries; heparin is used to thin the blood to again prevent the potential for blood clot formation. It's a little backward since treatment is started even before the diagnosis is confirmed, but it's only because heart muscle is so precious. It is better to treat a patient and prove that it's not a heart problem than to delay treatment for a patient whose heart needs help.