'Typical' signs do not present in everyone: in particular diabetics are at increased risk of having 'silent' heart attacks, And chest pain that is not typical may also be a heart attack.

An ECG can rapidly demonstrate that a patient is having a heart attack or as we call them myocardial infarcts, and excellent intervention is often possible.

If the above condition/pain is experienced and there is not a clear ECG picture of a heart attack troponin levels are taken at 6 hrs, an increase f which will demonstrate that there was cardiac specific muscle damage.

Without wanting to alarm anyone, there is in the US 250,000 sudden cardiac deaths a year, almost all from a coronary artery called the left main blocking: this vessel supplies a huge percentage of the heart muscle and when it blocks there is no warning and the heart doesn't have enough fuel to keep pumping.. These patients unfortunately almost all dead on arrival. There is very little that can be done to predict this as their first episode of chest pain usually results in death within minutes, and there are rarely indications that the patient is at risk of such a problem.

This often spirals into the terrible cycle of anxiety -> chest pains -> anxiety about the chest pains being a heart attack.

I can only assume that the chest pains will be different and more severe if I should ever have a heart attack.

http://www.calmclinic.com/anxiety/symptoms/chest-pain

In her case the deeper I delved into her personal life the more it became apparent that this was a clear cut case of stress/anxiety related pain- that was having physical manifestations.

for her, we discussed exactly what you are describing: that anxiety leads to the pain, which then leads to fear about it being a heart attack, which worsens it etc. we went through the work up we had planned and after her second troponin was negative we sent her home to have an outpatient stress test to see if she may have some partial blockages. If that is clear, we as medical personnel feel comfortable knowing that her episodes are non-cardiac in nature- and referral to psychologist for CBT (which she had previously undertaken to good effect) was recommended. I think she will do well, she appears willing to seek help.

I hope you are also seeking help for your anxiety, and that you have had at least one good work up for your chest pain to exclude a cardiac cause.

I execise regularly. If those device are effective, I would love to use them weekly or monthly on myself and collect the data long term for me and possibly my doctor.

For data collection or your own interest, a proper 12 lead ECG is a great reference item; but again if the machine is like [1] you are only going to get this simple trace that doesn't tell you much; even serial ECG's on a normal healthy patient (or even someone with moderate heart disease) will be almost perfectly normal day to day, month to month at rest.

So I would be inclined to suggest that it is a bit of a waste of money from any attempt at home diagnostics, however if you were concerned about your cardiovascular risk you should discuss it with your doctor.

[1] http://www.amazon.com/Medical-Real-Handheld-Portable-Monitor...

Is there such thing already?

Collect all 12 leads signal via bluetooth connection to a Iphone/Mobile device.

Whenever I do a 30,60 minutes exercise in the GYM, the system will collect all the data and store them in my personal cloud.

Whenever I did annual checkout with my PCP, I will go over the data/chart with him/her and see if there are any abnormalities that might trigger any concerns.

If they spot any potential issue, than we have more info to do proper stress tests in the hospital and lab setting.

Would this kind of device/process be valuable from your ( Doctor's ) point of view?

BTW, I have background in embedded system, cloud backend, and some mobile app, if any doctors think these kind of monitoring devices are useful. I can definitively love partner up working on such project. My mom suffered from heart attack a few years back - so this topic trigger a personal nerve for me.

EKG's have always been normal as has blood work when I did go to the ER. At my primary care doctor EKG's have also always been normal.

I have been in CBT and getting better but I have to say your post kinda opened a wound. The reason being my primary care doctor says I don't need a stress test and that the prior ones are good enough. She says given my age of 29 and risk factors there's just no reason for it. So far she's been right. Over the last 12 years the hundreds of times I have had chest pain I am not dead yet.

I guess now you have me a tad worried. My primary care doctor and her colleagues have been so convinced at times when I show up with chest pain they don't even think a EKG is necessary.

It certainly does sound that if you are known to a cardiologist. have previously had negative stress tests and have had recurrent episodes of the same type of pain with negative ECG's then you have been worked up appropriately to exclude a cardiac cause. Your primary care doctor knows you much better than I ever can over the internet so I defer to their more expert opinion and interpretation of your recurrent presentations. Take solace in the fact that previous investigations have shown the pain to be non-cardiac in origin.

That sounds like there was more than ample warning about the subject matter. If it's triggering, you might not want to seek it out?

This is mostly for men, right? I've read previously that the symptoms for women are quite different.

Her experience was very, very different from what we're taught to expect from a heart attack as men. She'd been nauseous and tired, with some chest tightness and general malaise, for a period of about 4 days before my stepdad told her to go to urgent care, where they put her on an ambulance to the ER, where they admitted her to the cardiac ward. She had been having a heart attack for most of that four-day span and wrote her symptoms off as "just part of being a 66-year-old woman." The length of the event caused her to go into shock, and she's had all sorts of problems falling out from that. She's stable now, at least, and is recovering well, but she should've sought medical care much, much sooner.

Since this happened, I've spoken with dozens of men and women I know about heart attack symptoms, and so far only a couple of people knew how different the presentation was across genders. If you have any late(ish)-aged women in your life about whom you care, make sure they know what a heart attack might feel like for them. My mom got lucky and has had a great team of doctors working on her recovery, but you can't count on luck the way you can count on knowledge.

There's no guarantee you'll have any pain at all... Honestly, someone who is diaphoretic and nauseated is going to get an ECG, even if they don't have any complaint of chest pain.

Luckily I recognized the signs and was very near a hospital ED. I wasn't in incredible pain, but I knew what was happening. I was actually driving and made the decision to get to the hospital instead of calling an ambulance, as the time would have been longer.

Got to ED, straight to a bed, then ECG and bloods taken, two hours later angiogram/plasty and now have a stent in the Circumflex artery and working on the other problems.

Fortunately it looks like the damage has been fairly minimal. Echo cardiogram shows mostly "normal", but getting a thallium test next week.

I'm T2 diabetic and had let my sugars get out of control.

Don't do that.

Now I'm doing the exercise and diet changes that I should have done a long time ago.

What were your readings at the time, if you don't mind?

I've resolved to undergo Angiography, symptoms or not, once I turn forty. Angiography is not cheap but it is way more cheaper considering the costs of stents (specifically the ones that dissolve are quite expensive). A day of preparation and an hour of discomfort is nothing at all considering the benefits.

Where are my darn nano-mites!?

By the way your heart doesn't feel pain itself no nerves for that, which is why there are all these other spots that get reported as uncomfortable or painful because the body "finds someplace else" to express the problem. The other sign is the shortness of breath and gasping...this must be simply because your body is responding to the heart not getting oxygen past the artery blockage (downstream)and is trying to get more oxygen. Note also when you get that second stent they are blocking an artery to insert it so you get a chance to experience the heart attack feeling as per shortness of breath if you missed it the first time.

How can we monitor this effectively? There must be a solution that does something after something has registered a problem.

https://en.wikipedia.org/wiki/Coronary_catheterization

I therefore believe that a smart watch would not with any current technology be capable of detecting a heart attack.. Pulse and heart rate are simply not useful (neither sensitive or specific) criteria for detecting MI's

For further reading on the physics of an ECG hit up

http://en.m.wikipedia.org/wiki/Einthoven's_triangle

Edit: my ECG knowledge is a bit rusty- 2 points of contact is enough to produce a single waveform reading...

Any just to clarify further... you'd need two points of contact that complete an electrical circuit. You couldn't just wear another watch.

You _could_ wear two watches and have a small wire that you use to connect them together when you want to check, but that's only going to give you Lead I, which is one of the less useful leads (and it's completely useless in isolation).

If you really wanted to get crazy, a watch on your right wrist connected to an anklet on your left ankle would give you Lead II, which could at least get you a look at the inferior aspect of the heart (and therefore the RCA).

But I'm just getting silly now... If you think you're having a heart attack, call an ambulance. They'll do a full 12 (or 15) lead ECG right in your bedroom.

http://en.m.wikipedia.org/wiki/Straw_man

The important idea is that I'm not asking the wearable to tell someone that they're having a heart attack but simply indicate some one "test" is not within range.

Really the only thing I can think of is some sort of transcutaneous monitoring of troponin levels in the blood, but that's hard to do (without needles) and a late indicator... troponin levels don't start rising for a few hours after the damage has started.

Apparently I'm weird because I wanted to watch the angio. They kept telling me that they "didn't need my help" :)

I was saying "how often do you get to see your insides?"

If the area of infarct impacts a part of the heart responsible for electrical conduction, stuff like that can absolutely happen, but it's not especially common.

I have a statistical medical question. Is the problem that they're completely unrelated, or that interpersonal variation is larger than the typical impact?

Very long term data analysis with a sudden change might be much different than the experience of a ER doc seeing someone for the first time.

I guess the relevant data source would be someone hooked up to monitoring gear in the hospital when they have a second heart attack while onsite... it might not even be visually obvious but perhaps a detailed statistical analysis would show something before/after.

Edit: Apparently I'm wrong, I know nothing about ECG.

Chest Pain The first and most obvious sign is chest pain. It may be radiating down your left side (jaw/arm). It is generally described as a crushing pain. This symptom is less likely to occur for women or people with diabetes. If the chest pain is not relieved by resting (i.e. sitting down), it points towards a heart attack.

Shortness of Breath As a body attempts to bring more oxygen into the body faster (because your heart isnt perfusing efficiently anymore), breathing will become faster and more shallow.

Pulse - Rapid, Weak You should take your pulse a few times a year to get a baseline of what it's normally like. During a heart attack, it can become faster and weaker. However, this is relative - your pulse may normally be weak. This is why it is important to have a baseline.

Nausea, Dizzyness, Sweating, Weakness These physical symptoms by themselves are usually not a concern (they happen with many sorts of illness really) but in combination with the above can be a warning sign.

In any discussion about heart attacks, it's important for you to understand the risk factors: http://www.mayoclinic.org/diseases-conditions/heart-attack/b...

If you're high risk and are suffering from the above symptoms, its always advisable to err on the side of caution and call the emergency services. In fact, if you're at all worried, just call.

There are some things you can do to help yourself during a heart attack: 1) Call emergency services. 2) Make sure emergency services can access you, especially if you're on your own. Unlock door, etc. 3) Half sitting position. Place your back up against a wall and sit with your knees raised. 4) Take an aspirin. This will thin your blood and relieve pressure on your heart. 5) Try control your breathing. 6) Try not to worry (yeah, I know, this is a hard one).

Source: EMT (Emergency Medical Technician) with voluntary ambulance services.

But if you have repeated episodes of chest pain relieved by resting, it might point to angina pectoris -- not technically a heart attack but potentially serious. If it's unpredictable pain and not relieved by rest, it could be unstable angina and much more serious. Yet another thing that makes heart trouble difficult to distinguish from anxiety.

I later had a huge pain in my elbow. It was as if a big nail was hammered through it. I then went to my cardiologist and he noticed a change in my ECG. I did a ECG under effort and he stopped it after a minute. My ECG became completely crazy under effort. I saw it later. From this point things went as routine work. Got a stent and everything is now ok.

So symptoms my differ. I never had chest pain. Only elbow pain. The tooth pain was also a hint I now monitor. When it hurts I know I have to be careful with what I eat. It then calms down.

Strangely enough I'd just seen the poster that had all this on it the week before my attack when I was at the GP for a general checkup after a cold.

My question is why can't we detect this high level of blockage much earlier (as in with a physical). Are the tests too intrusive or too expensive to recommend that the test(s) be performed periodically (eg maybe every 5 years after 30 or 40?)

Thanks!

The gold standard for detecting vessel blockage is angiogram- puncture the femoral or radial artery, feed a catheter to the top of the aorta and squirt some dye and then watch it on X-ray. This has risks however- risks of rupturing artery walls, causing bleeding and bruising, and can be expensive. So it is not routinely done: in fact it is only indicated if a patient presents with a MI (gold standard is to have the patient in angio lab within 90 minutes of onset of symptoms, which is great because if they are they can generally reverse the blockages with stenting before long term damage occurs), or if a patient has a positive stress test.

CT angiograms are becoming more common but still not commonly used due to decreased sensitivity.

If a patient is believed to have risk factors for artery disease then they may be given a exercise stress test- hook up to an ECG, get on a treadmill and if there are changes consistent with vessel ISCHAEMIA (as opposed to infarct), then an angiogram will usually be scheduled.

For patients too unwell for a exercise stress test nuclear medicine stress tests can be performed.

And finally in patients who have blockages in more than 3 arteries, the gold standard is still (for the time being) coronary artery bypass grafting.

I guess to summarise, the reason we can't detect it earlier is because generally we require invasive means to do so and invasive tests carry risk to the patient that are hard to justify for screening purposes. Perhaps in the future CT angio may be made more readily available, the scanners keep getting better and better and resolution increases all the time however you always want to minimise a persons radiation dose as for every 3-400 people scanned you can cause one instance of cancer... Something you must always be mindful of particularly in children

The interesting thing (aside from watching the angio, the technology is very cool), was that I'd previously had a minor infarct and didn't know it on a much smaller artery.

They found collaterals (I think the terminology is right) where the body "bypasses" the blocked artery.

Bizzarely this leads to situations where diabetics (who develop lesions all along their vessels, and thus have lots of areas of narrowing) can potentially be more protected from a sudden blockage compared to someone with an area of only one blockage - they have enough collateral circulation that the area of infarct is smaller with less damage resulting

No, not really, but hey, its worth clutching at straws...

- Feeling diffusely sick, no specific pain, but a feeling that something was wrong.

- Oppression in the chest.

- Mild pain in the left arm

- Cold sweat.

I tried to drink some water, open a window to have fresh air, sit and relax, but after a couple of minutes nothing improved. I was at the office (alone) so I googled the symptoms of a heart attack and next thing I was calling 112 (Spain's equivalent to 911).

It was a mild heart attack, I got a procedure in the ambulance that stopped the attack, and a barely had heart damage. I had a triple bypass surgery a week after the attack, because the three main arteries were clogged. So it went well, because with those arteries I could have had a more serious attack at any moment.

My advice would be, if you are not feeling right and you never before had those symptoms, call 911 (or whatever the number is in your country). The people that picks up the phone are trained to assess the calls, and anyway it's better to raise a false alarm than to die.

I've never had shortness of breath while not active. That's also what the doctor told me to look out for. It's still scary and confusing though.