Medication Side Effect or Heart Attack?
Pressure in the middle of my chest.
Can't breathe in all the way.
My left arm feels funny.
My back hurts.
My heart is beating really fast.
This was me on a recent Sunday. I spent some time lost in feeling crappy, but then my brain finally kicked in. In February, I wrote a post about women and heart attack, so I looked it up. Lo and behold, my symptoms sounded very much like those experienced by women having a heart attack.
On the other hand, there were also other explanations for my symptoms. I just had finished a week with very high pain levels, during which I had taken more of the "big painkillers." They are notoriously hard on my stomach, and my GERD had been acting up. When it does, I often experience the sensation of pressure and back pain. Moreover, I'd been on a lovely walk in the woods the day before, during which I took a lot of photographs and my left shoulder was feeling the effects. Lastly, I was exhausted from an intense two weeks. I decided to take a "wait and see" approach, and promised myself that if the symptoms persisted, I'd go to the ER in the evening.
I can hear you howling at me now. Seeing it written out like that, it doesn't seem like a good decision to me, either.
I did feel better in the evening, but when the symptoms were still there the next day, if not quite as intense, I stopped by my family doctor's office to get checked out. As my doctor is a very sensible woman, she did an ECG.
"It looks a little funny," she said gently.
"What do you mean, 'funny'?" I asked.
"It looks like you've had a heart attack," she said. This did not help my heart rate slow down. Before I knew it, I was in an ambulance on my way to the ER.
My visit to the ER
Once I got to the ER, I spent some time in triage. There they did another ECG, mentioning that it looked "squiggly." Before I panicked, the nurse told me that it was due to technical reasons, not another heart attack. After moving the electrodes around, she got a good ECG and I got a room.
There was a fair bit of waiting, which I decided was a good thing. It made everything less serious than if I had been surrounded by medical staff. My heart rate was still up there, partly because it seemed to be what it wanted to do and partly because being sent to the ER with a heart attack is really scary.
Over the next two hours, I had some blood drawn and someone took my medical history. Much of the two hours was spent waiting for the results of my blood tests. Whereas the ECG may indicate a heart attack, it can be wrong depending on electrode placement. One of the blood tests I had done was Troponin levels. When someone has a heart attack, their Troponin levels go up, indicating damage to the heart muscle.
After two hours, the ER physician came to see me. Much to my relief, he told me that my blood tests showed I had not had a heart attack. My symptoms were caused by GERD activating a hiatal hernia. As I've had these symptoms before, this made a lot of sense. I was very happy to be discharged.
Managing medication side effects is a continual effort to balance taking the medication you need for your RA and pain, while paying attention to their less desirable effects. This experience made me realize that I've been gradually losing ground in managing my GERD. I discussed it with my family doctor in my follow-up appointment, and we're going to try another PPI medication. I'm also going to ramp up the other techniques I use to manage my GI effects.
In addition, I intend to ask for a stress test and a possible referral to a preventative cardiologist. Although my RA has responded well to biologics, I've lived with uncontrolled inflammation for most of my life and want to make sure that we manage my RA-related risk of heart attack and stroke. Lastly, should this happen again, I need to ask for some guidance so I know more about when to call an ambulance and when to wait and see.
This experience has also made me reevaluate another part of my life. I've spent the past week trying to calm down my GERD, and it is finally getting a bit better. Nonetheless, the symptoms come back every time I go to my computer to do some work. Obviously, stress is a big factor. I need to find a way to balance work and rest, as well as paying more attention to the life part of my life.
Symptoms of heart attack and what to do
When you live with RA, you also live with an increased risk of heart attack. As such, you should know the symptoms of heart attack:
- Pain, discomfort, a sense of pressure or fullness in the middle of the chest. This can last a while or go away and come back again
- Discomfort or pain in other areas of the body, including arms, stomach, back, neck and jaw
- Shortness of breath
- Cold sweat, nausea, lightheadedness.
- Women are more likely to experience a sense of pressure, nausea and vomiting, or pain in the back or jaw
If you have symptoms of a heart attack, call 911. Don't drive yourself to the ER or have someone else drive you. Paramedics can help you survive if you lose consciousness or have another heart attack, but a spouse or cab driver cannot. And most importantly, don't be like me. Don't wait and see if you'll get better. It's better to go to the ER and be told that your heart is fine. You may also want to start a conversation with your doctor about preventive measures. Keep your heart healthy.
Lene Andersen writes the award-winning blog The Seated View. She's the author of Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.