DIAGNOSIS OF HEART DISEASE: HEART ATTACK OR ACUTE INDIGESTION
“I think it’s just acute indigestion, doctor, but it won’t go away.” The voice came from a sixty-year-old man lying on a bed in the emergency room. “It started about four hours ago, although I had a little bit of it last night.” The patient made a fist and laid it over his upper chest. “It’s a bad pain right about here. At times I feel it going over to both shoulders and up into my neck.”
As the doctor felt the patient’s pulse, he noted that the patient’s color was pale, that his skin was cool and damp, and that his breathing was slightly rapid. His story was interrupted as he paused to catch his breath.
The doctor rapidly examined the sick man and just as quickly made an electrocardiogram. His suspicion was correct. The patient had an acute myocardial infarction (a heart attack). He was wheeled away on a litter and minutes after was under the care of a special team in the Coronary Care Unit. An hour later the patient was dead. Frustration was written on the faces of the nurses and doctors who had tried to save him. If he had come in an hour or two sooner, they might have done it.
This story is a painful one that repeats itself over and over again in the hospitals of our country. “It’s just indigestion, doc.” Probably half of the people who have a heart attack mistake it for acute indigestion. Perhaps they think it is their heart but are afraid to admit it to themselves.
What is acute indigestion? What causes it? Strictly speaking, indigestion means incomplete or difficult digestion of food. In itself, this situation would probably not produce any symptom other than a sensation of fullness in the abdomen. People who use the term indigestion are usually referring to other things.
One common problem in the intestinal tract that is confused by people who have “heart pain” is a disorder called hiatal hernia, or a diaphragmatic hernia. This is a condition in which a small part of the stomach is able to slide up into the chest through an opening in the diaphragm. The diaphragm is the muscular structure that separates the heart and lungs from the organs of the abdomen. The esophagus, the tube that carries food from the mouth to the stomach, passes through a hole (hiatus) in the diaphragm. When a person has a diaphragmatic hernia, this normal hole is larger than it is supposed to be, and when he lies down, part of the stomach slides up into his chest. This occurs only when the person is lying down, because when he is sitting or standing, gravity pulls the stomach down low in the abdomen. If a person has symptoms from this problem, one is usually a feeling of pressure or general discomfort in the upper abdomen or the lower chest. Sometimes this hernia can produce severe pain.
The clue to the diagnosis of the hernia is that usually the pain starts sometime after the person has gone to bed after a large meal. The sooner he goes to bed after a meal, the more likely he is to experience discomfort. Furthermore, most patients find that they get relief from the pain if they sit up in bed, or better yet, if they get up and walk around. On assuming a more upright position, the stomach returns to its normal position and the pain disappears. The diagnosis of this condition is confirmed by an X-ray of the upper intestinal tract.
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