Listening for Ischemia
One of the major concerns people have, and one of the main things we look or listen for, are complaints that could be generated from a heart in trouble, and we know it’s not always the classic presentation of crushing chest pain with radiation down the arm and into the jaw; skin turning diaphoretic and ashen as they start gasping for air, one hand clutched to their dying heart.
This may happen with more frequency than other types of presentations, though I think there may be a question about if it truly is the dominant presentation for cardiac injury, or if that’s just what was historically focused on and watched for, to the exclusion of other types of symptoms or presentations.
It honestly seems to get lost in the crowd of various other ways people can have symptoms. The major thing to listen for and sort out is if their symptoms are stable or unstable.
Whatever signs or symptoms they are having; if they get bad with activity and then get better with rest, they may have a little time. If symptoms happen suddenly, or with activity, but then don’t get better with rest, that needs sorting out or intervention right away.
Are symptoms stable or unstable?
If symptoms are stable, it may be ok to continue to monitor for any unstable symptoms while we sort this out
If symptoms are unstable, that needs to be sorted out ASAP, with an urgent visit, acute evaluation through the ER, or via 911 if it’s not looking like we are going to get answers or direction in a short time frame. This is the kind of situation where people really just want things to just be fine, and denial on the part of the patient or care staff can be dangerous.
The standing bit of patient advice here is: if symptoms would worsen or change and become concerning, please seek acute evaluation through an ER, urgent care, or 911.
The Story of Stable Symptoms
Imagine sitting on the couch breathing through a straw. This may be a little unpleasant, but for most people would be doable until they get up to do something.
Doing something while forced to breathe through a straw would suck, and the heart runs into a similar situation when it has blockages or reduced perfusion; at rest, it can get enough fresh blood to be ok, but when you get active and start demanding more of it, every cell on the other side of that bottle neck feels like it’s breathing through a straw while doing chores, and as we discussed earlier, that sucks.
Stopping your chores and sitting down to catch your breath through the straw may be tough once you’ve been busy, but eventually you should level out and be back to ‘ok’. The heart tissue on the other side of a restriction feels and acts the same.
The real ‘oh shit’ moment is when symptoms don’t get better. Now that straw may be plugged and you may be having unstable symptoms. Someone needs to intervene. Now.
