Understanding how heart attacks are evaluated
Ask an Expert. Cardiologist Dr. Abdul M. Sheikh explains how heart attacks are evaluated and what patients often misunderstand.
What is the first thing going through your mind when a patient comes in with symptoms of a heart attack?
The first question is what the EKG shows. The findings on the EKG determine how urgently we need to act.
If the EKG shows a STEMI, or ST-elevation myocardial infarction, it means there is likely a complete blockage of a coronary artery. This requires immediate treatment with a heart catheterization to find and open the blocked artery, usually with a stent.
If the EKG does not show a STEMI, there may still be a significant blockage, but it is less likely to be completely blocked. In these cases, we often start with medications and then decide if a catheterization is needed.
What do most patients get completely wrong about heart attacks?
A common misconception is that heart attacks only happen to older people, smokers, or those who are out of shape.
While these groups are at higher risk, heart attacks are increasingly being seen in younger patients, even in their 30s.
If someone has persistent chest discomfort that is not going away, it is always better to get it checked rather than assume it is heartburn or a muscle strain.
What is the most surprising diagnosis you have seen hiding behind what looked like a heart attack?
Several serious conditions can mimic a heart attack. Two of the most important are aortic dissection and pulmonary embolism, both of which can also be evaluated in the emergency setting.
Other less dangerous but still surprising causes include esophageal spasm and even stress or anxiety.
THE BOTTOM LINE
Chest pain does not always mean a heart attack, but it should never be ignored.
Early evaluation helps identify serious conditions quickly and ensures the right treatment.
About the Expert
Abdul M. Sheikh, MD is a board-certified interventional cardiologist.
This article is for educational purposes only and is not a substitute for medical advice from your own healthcare provider.