Monthly Archives: April 2014

Oh hell

Oh Hell, that hurts!  I sat down in a hurry. My first thought was “I’m having a heart attack.”  My second was “Don’t be silly you’re only 49 and probably just gobbled lunch too quickly, again.”  Jess came up to me and said “Gosh, you look pale.”  I mumbled something about a bit of pain.  It bit again, Jess noticed my grimace and said the inevitable “We should call a doctor.”  I tried to argue but to be honest, felt lousy and a little bit scared.  Before, I knew it I was bundled up off to the Emergency department.

Rule #1: Never ignore chest pain!

Rule #1: Never ignore chest pain!

As soon as I got in ED there were nurses and doctors questioning me, taking some blood, and sticking little metal electrodes all over my chest.  I later found out they were measuring in my blood something called troponin which goes up with a heart attack (well… they used the words like myocardial infarction and acute coronary syndrome … but all I cared about was whether I was having a heart attack or not).  The electrodes I learnt were measuring the electrical activity of my heart – they called it an ECG.  They told me that if either the troponin levels were high or the ECG squiggles were not where they were meant to be then I would be admitted to the cardiology ward.  They were going to repeat all the measurements a couple of hours later.  I was a little annoyed by all the questions to start with, but I soon learnt that sometimes the troponin levels are low and the ECG negative but people can still have a serious heart problem.  They use the questions to come up with a risk score which helps them make a clinical judgment.  The questions were about the usual stuff – smoking, family history of heart disease etc as well as some specifically about where the pain was, what kind of pain (mine was definitely sharp), and whether it moved to the arms or shoulders.

Pretty soon after I arrived someone came up to me who called herself a research nurse and asked if I would consider joining a study. She was lovely. She explained the study was all about trying to rapidly rule out a heart attack.  Apparently only a quarter of those presenting with chest pain actually have a heart problem needing attending too.  However, it’s difficult to tell quickly if someone is in that quarter or not and so a huge percentage of patients get admitted to hospital, usually staying overnight, and certainly costing the tax payer heaps.  Well, I’d just paid a massive tax bill so I signed up pretty darn quick.  Also, I can’t stand hospitals and so I’ll support anything that keeps me out of them!  Of course, this research wasn’t going to help me now, but who knows in the future.  Actually, for the price of another round of questions and a little more blood (fortunately they didn’t need to stick any more needles in me) it seemed a small price to “do my bit” for science… ‘All I have to offer you is blood, sweat…’

After a couple of hours and a repeat of all the tests, I was told they had all come out negative and my risk score was low.  The docs saw nothing else that rang alarm bells.  They signed me up for a treadmill test the next day “just in case” (served me right, I’d been avoiding the gym) and sent me on my way.  I felt a bit of a berk, but they were so good to me and kept reiterating that it is much much better to be safe than sorry.  Besides, I got to participate in some science which was rather cool.

____________________________________________________________

Author’s note:  Research in Christchurch Hospital Emergency Department lead by Dr Martin Than has enabled nearly a doubling of the numbers of people in whom a heart attack can be ruled out early.  I have been fortunate to join the team this year as we run a randomised controlled trial of two scoring regimes to see if one will increase the rates of safe early discharge.