Symptoms
The symptoms of the incubation pain can be of different types. Some patients feel them when breathing in, others generally at rest, and some only under stress. The symptoms give an indication of the type of illness.
Seizure-like chest pain, which disappears after a few minutes, can be a sign of angina pectoris. Bruising pain in the middle of the chest, around the whole thorax, may indicate intercostal neuralgia. It is not uncommon for patients to experience anxiety and shortness of breath.
A stabbing pain over the middle of the ribcage, radiating into the left arm, is considered the classic symptom of a heart attack. However, it can also manifest itself in a completely different way, especially in women, where the symptoms are often very different: some patients go to the dentist with recurring toothache, and in the end it turns out that the pain comes from the heart. Due to their polyneuropathy, diabetics often feel no pain at all and are therefore particularly at risk.
Rib fractures or bruises are usually caused by a traumatic event, and there is no need to assume a cardiac event in the first place. A typical clinical picture of a serial rib fracture is paradoxical breathing: when breathing in, the thoracic instability causes the rib cage to contract instead of expanding. All symptoms have in common that coronary heart disease should never be completely ruled out by the examiner.
Therapy
In the event of a heart attack, the patient should first be calmed down, constricting and tight clothing such as a tie or tight trousers should be removed, and fresh, cool air should be provided. Under no circumstances should the patient be laid down, as this will cause blood to flow from the legs towards the heart, putting additional strain on it. An “upper body high” position is recommended.
If the patient has a pump spray like Nitrolingual, it should be applied immediately. In addition, the rescue service must be informed immediately, the detour via the treating family doctor costs unnecessary time. The emergency doctor usually proceeds according to the MONAH scheme: Morphine for the pain, oxygen to saturate the rest of the blood in the body as much as possible.
Furthermore N for nitrates, such as Nitrolingual, to dilate the vessels, and ASS plus heparin to liquefy the blood as quickly as possible. This is followed by a rapid transport to the nearest CPU (Chest-Pain-Unit), where the vessels are further supplied (mostly cardiac catheterization). In case of traumatological events, such as sports injuries or neurological problems, there is usually no danger to life.
The therapy is carried out by means of sparing, and possibly pain medication against the chest pain. A psychosomatic diagnosis may only be made after all other possible illnesses have been ruled out, and we then provide psychosomatic therapy. However, the patients’ cooperation (“compliance”) is relatively low here, which makes the therapy more difficult. In any case, it is advisable to ensure a healthy lifestyle with as little stress as possible, even if one does not wish to accept the therapeutic concepts of psychosomatic medicine for the time being. After all, success in one’s profession is of no use to one if one dies at a young age.
