Heart-attack pain is highly variable


DEAR DR. DONOHUE: My mother-in-law had chest pain in the center of her chest. The emergency-room personnel told her it was indigestion. By the time it was diagnosed as a heart attack, 24 hours later, it was too late to save her. Please add this to your description of heart-attack pain. – N.N.

People experience a huge variety of different pain sensations on having a heart attack. The pain is described as burning, crushing, pressing or squeezing. It can be felt under the middle of the breastbone or in the left side of the chest. It may spread to the right side of the chest, the left or right shoulder and arms, the upper back, the neck, the jaw or the upper abdomen. One usually consistent feature of the pain is that it lasts for half an hour or more.

There is so much variability to heart-attack pain that other clues have to be taken into account in order not to miss an attack. One-quarter of heart-attack patients have no pain. Fatigue can be the sole symptom – a fatigue that is not sleepiness but such a total loss of energy that it’s hard to hold the head up. Nausea and vomiting can accompany a heart attack or can be the only signs of it. Sudden shortness of breath is another common sign.

Tests confirm a heart attack. The EKG usually shows clear evidence that a heart attack is occurring or has occurred. Blood tests are also helpful. Creatine kinase is an enzyme found in heart muscle, and a rise in its blood level is a tip-off of a heart attack. The same goes for the blood test for troponin, a protein found in heart muscle.

Your mother-in-law’s story is not something that happens often, but it is something that does happen. A patient might have none of the signs or symptoms of a heart attack. All tests might be normal. The patient is dismissed, only to die at home – a tragic chain of events about which everyone is desolate.

Heart attacks and related problems are North American’s No. 1 killer. The booklet on this subject explains what’s happening and what to look for. Readers can obtain a copy by writing: Dr. Donohue – No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: A young, wonderful person is dying of pancreatic cancer, and the doctors won’t even try to operate. This dear soul will die shortly anyway, so why not operate? Can’t doctors learn something by doing this sort of operation?

I was sent a booklet on pancreatic cancer, and the booklet says it can be operated on. The booklet also said that cancer cells are attracted to iron. So the doctors give patients iron in some way with something else added. As soon as the cancer cells go for the iron, this other element explodes the cancer cells and they die. Why don’t all doctors know this? – S.C.

Your heart’s in the right place, but your idea is in the wrong place.

Doctors can operate on some pancreatic cancers. It depends on the cancer’s location and whether the cancer has spread outside the pancreas. Operating on a person with inoperable cancer violates one of a doctor’s basic codes – do no harm. The operation would only cause the person greater pain with no benefit.

I am sorry to say it, but the exploding iron story sounds like fantasy to me. Throughout the world, the best minds in medicine have been devoted to finding treatments and cures for all cancers. A breakthrough in treatment is not going to come in a mailed booklet. It’s going to be announced in a scientific journal and then appear in all the media.

DEAR DR. DONOHUE: I have an anecdote about nighttime leg cramps. If I eat a handful or two of cashews, I get leg cramps. Getting off cashews stopped my cramps entirely. Do you know any discussion that supports this? – T.S.

I don’t. I’ll pass your information along and wait for confirmation or denial of your observation.

DEAR DR. DONOHUE: I have been on Coumadin for two months because I had a blood clot in my leg. My friend also takes it for a heart problem. I had lunch with her, and when I ordered a salad, she had a fit. She said that the salad greens inactivate Coumadin. My doctor never told me to watch what I eat. Am I in trouble? – K.C.

The story begins with vitamin K. Without vitamin K, the body can’t make many clotting factors, proteins that float in the blood and aid in forming a clot when a blood vessel breaks. Coumadin inhibits the production of clotting factors that depend on vitamin K. In other words, it “thins” blood, meaning it makes it less likely to form a clot. That’s the goal of a person who has had a vein blood clot. It’s also the goal of people with atrial fibrillation, the heartbeat disturbance where the upper heart chambers are no longer beating; they’re fibrillating – squirming in an uncontrolled fashion. Clots form in fibrillating atria. I’ll bet that’s the reason your friend takes this medicine.

People on Coumadin ought not to take vitamin K, unless cleared by their doctors. Too much vitamin K can block Coumadin’s blood-thinning properties.

Green, leafy vegetables, broccoli, cauliflower, spinach and cabbage are good sources of vitamin K. Some doctors tell their Coumadin patients not to eat these vegetables. However, complete abstinence isn’t necessary. So long as you don’t gorge on them, so long as they are a consistent part of your diet and so long as your blood tests show you’re getting enough Coumadin, you don’t have to make a fetish of avoiding these foods.

Your lab tests must have shown that your blood has been thinned enough in the past two months. If it were not, you would have heard from your doctor.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com