Chest Pain, Vomiting, Heart Attack, Anxiety: How Are They Related?
Chest pain with sudden nausea leading to vomiting, along with sudden sweating and/or shortness of breath can mean a heart attack either in progress or soon about to happen.
“The vagus nerve provides connection between the gut, the heart and the brain,” says Sendhil Krishnan, MD, a board-certified adult general cardiologist with advanced subspecialty training in interventional cardiology.
“Over-stimulation of this nerve, such as during a heart attack [or imminent heart attack], can lead to feelings of anxiety with the commonly described ‘sick to my stomach feeling.’ This can also lead to nausea and vomiting.”
My mother was having shortness of breath and had upchucked.
I urged her to go to the ER because I had read somewhere that vomiting for no reason in a person at high risk for heart attack can actually mean a heart attack in progress or about to come.
She was discharged from the ER — after various tests turned out normal — with a diagnosis of acid reflux.
But three days later … she was on the operating table undergoing quintuple bypass surgery and mitral valve replacement.
Heart Attack Suspicion in Elderly People with Chest Pain
Depiction of heart attack. Credit: J. Heuser
The index for suspicion of a pending heart attack in the typical elderly person with chest pain or sudden shortness of breath at rest should be very high.
To this day I will never know why the emergency room physician leaned much more towards the idea of some kind of digestive issue rather than a heart attack waiting around the corner.
Two days after her ER discharge, my mother then had complained of chest pain.
I took her back to the ER where she was then admitted after a blood test turned up abnormal — but not abnormal enough to diagnose a heart attack.
The next day a catheter angiogram revealed dangerous blockages in five arteries, and she went under the knife several hours later.
Anxiety has been noted as a sign of a looming heart attack, but more striking is that of vomiting.
It was that vomiting — even though it was just a little bit — that really tipped me off that something was wrong with her heart.
“I am also an interventional cardiologist which means I perform catheter-based interventions on patients having acute heart attacks,” says Dr. Krishnan.
“Again, there is involvement of the vagus nerve which can lead to this response of nausea and vomiting which is mediated through a reflex known as the Bezold- Jarisch reflex.”
Why hadn’t this symptom tipped off the emergency room doctor?
I had told him about it. He was more convinced that it was acid reflux!
Screw acid reflux! Ultimately, three physicians all told me that if my mother did not undergo quintuple bypass surgery immediately, she’d likely suffer a massive heart attack within a week.
Trust Your Gut Instinct
“For patients it’s important to note that sudden onset of nausea and vomiting associated with chest pain, sweats, shortness of breath or a sense of impending doom really may be the start of an acute heart attack, and they should seek medical attention immediately,” says Dr. Krishnan.
Dr. Krishnan is with Pacific Heart & Vascular, where you can view his videos on heart disease and healthy living. He has numerous publications and often speaks at local and regional events.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: ©Lorra Garrick
Cancer Symptoms Can Masquerade As Harmless Condition
Cancer is so ruthless that its symptoms can fake a person, even a doctor, into thinking that its symptoms are being caused by a harmless condition–especially when the symptoms come on very small and gradually.
Many symptoms of cancer are also symptoms of many benign conditions.
And many symptoms of a malignancy are also signs of other conditions that are life-threatening.
An example is a hoarse voice. A person’s first thought might be throat (laryngeal) cancer, or that of the lung.
However, a hoarse voice can also be a result of something as harmless as an infection or acid reflux.
It can also mean a thoracic aortic aneurysm, which is life-threatening.
Burping
Excessive burping can be a sign of cancer. Now certainly, few people would ever wonder about this, because burping has always been associated with lacking manners or performing the loudest one at a party.
Burping has also always been tied to eating too much or too quickly, drinking too much carbonated soda or gulping air with each bite or sip of beverage.
But actually, ongoing burping with no explanation (e.g., inhaling a lot of air while gulping soda) is cause for concern — especially if there are other symptoms such as abdominal pain.
IBS vs. Colon Cancer
Unfortunately, the symptoms of these two conditions overlap significantly.
What further aggravates this fact is that there is no clinical test or exam that verified IBS.
IBS is a diagnosis of exclusion. This exclusion includes a colonoscopy.
So in order to get a diagnosis of IBS, you’ll need to undergo numerous tests including a colonoscopy — because the signs of this benign condition and colong cancer are nearly identical.
A Changing Mole
Does a changing mole have you petrified that this could be melanoma?
Actually, melanoma isn’t the only reason that a mole would begin showing changes.
Nevertheless, if you’ve noticed any kind of changes in a mole’s appearance, you should immediately make an appointment with a dermatologist.
With that said, there are several benign circumstances that can “change” a mole.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Lightspring
How Likely Will Esophageal Cancer Come from GERD?
People with chronic GERD may know this can cause Barrett’s esophagus leading to esophageal cancer.
“Risk of GERD developing into esophageal cancer is very low,” says Dr. Maxwell Chait, MD, gastroenterologist at ColumbiaDoctors Medical Group in Westchester County, NY.
Dr. Chait adds, “It depends on the development of Barrett’s esophagus. Ten to 15 percent of people with GERD will develop Barrett’s esophagus in their lifetime.
“The risk of Barrett’s going on to esophageal cancer is less than 1 percent per year: 0.4 to 0.5 percent.”
What is Barrett’s esophagus?
It’s when repeated exposure of lower-esophagus cells to stomach acid results in damage to these cells.
Though the odds of developing esophageal cancer in one who has Barrett’s is very low, as stated by Dr. Chait, the patient still needs regular monitoring to detect any precancerous cells in the esophagus. Treatment at this stage will prevent development of the cancer.
Though many people with Barrett’s do not present with symptoms, here are the key signs: difficulty swallowing food, frequent heartburn, upper abdominal pain, chest pain and dry cough.
As you can see, these symptoms are also key signs of other unrelated ailments.
For example, the symptoms of just chest pain and cough can mean a thoracic aortic aneurysm.
The symptoms of difficulty swallowing food and a cough can result from laryngeal cancer.
The symptom of just difficulty swallowing food can mean many things.
The symptom of only upper abdominal pain can mean pancreatitis.
Chest pain by itself can mean a host of problems including a heart rhythm disorder, heart disease, imminent heart attack, emotional stress and soft tissue strain near the sternum from exercise.
Don’t try to diagnose yourself if you haven’t yet been diagnosed.
See a physician for appropriate tests until the problem is found.
If GERD and Barrett’s esophagus are closely managed, esophageal cancer can likely be prevented.
Dr. Chait’s practice interests include digestive conditions such as colon cancer, gastrointestinal endoscopy and internal medicine. He has authored numerous publications in reputed journals.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Kateryna Kon
Calf Pain Only When Walking: Likely Cause
Have you been experiencing mysterious calf pain only when you walk?
Perhaps it’s in one calf, or maybe it’s in both.
Nevertheless, this area never hurts while you are seated or sleeping.
It’s only when you walk that the pain kicks in. What’s puzzling is that you haven’t done anything recently to incur any discomfort such as running extra hard or spending all day climbing hills.
The problem may very well be peripheral vascular disease (PVD).
“Peripheral vascular disease typically causes achy, crampy pain in a certain muscle group supplied by a certain artery,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
Dr. Gashti adds that the location is “most commonly calf muscles, after walking a certain distance.”
“The hallmark of pain caused by PVD,” continues Dr. Gashti, “is that it is very reproducible.
“Since the arterial occlusion is a constant, meaning the blockage is there every day, patients complain of experiencing calf pain EVERY TIME they walk from point A to point B.”
Dr. Gashti gives the example of a person who walks every day to a bus stop, and every time feels calf pain.
If the problem has been going on for a while with no let-up, and if the person has risk factors for PVD like smoking, high blood pressure, high cholesterol and diabetes, “then the chances are that they have PVD.”
Persistent pain in the calves should not be ignored. Below is an image of what chronic PVD looks like.
Chronic PVD. James Heilman, MD, CreativeCommons
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm. He received his medical degree from University of New England College of Osteopathic Medicine and has been in practice for more than 20 years.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Morrowind
Should You Avoid Running with a DVT in Your Leg?
Running with a DVT? Risky or safe?
“Since running would significantly increase arterial flow to the lower extremities, and therefore venous return is also increased, it may be safer to avoid running in the ACUTE (when the clot is fresh and prone to breaking off) period,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
That makes a lot of sense, even though it’s not the news that an avid runner wants to hear.
Dr. Gashti continues, “After 2-3 weeks, these clots become more chronic, and risk of embolization would be decreased.”
There is another important factor to consider, however:
“What I will be more concerned about in someone with an acute DVT and running is that they most likely would be on anticoagulation (coumadin), and they have to be careful not to fall or sustain any other injury, since the risk for massive bleeding would be increased while on this medicine.”
Signs of a DVT
- Unexplained redness or ruddiness in a localized area of the leg, particularly the calf
- Soreness or discomfort in that area — not just when walking or using a staricase, but also at rest; sitting down or lying down does not relieve the pain. This is concerning.
- The area (which may not be red) seems unusually warm to the touch.
- If part or all of such a blood clot breaks loose and travels to the lungs, common symptoms would be chest pain and/or difficulty breathing.
- It is estimated that about half of DVTs do not present with symptoms involving the leg or pelvic area where the clot is, but this doesn’t mean it can’t dislodge and get into the lungs.
If you’re a runner and have recently sustained a very long plane flight, and you develop a mysterious cramping or pain in a leg, especially a calf, pay very close attention to this.
It would be a safe choice not to run until you’re sure that you don’t have a DVT.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: ©Lorra Garrick
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DVT in Your Calf: Is Lifting Weights Safe or Out?
Can working out with weights harm that DVT in your calf or possibly help dissolve it?
Being that a sedentary lifestyle is one of the many risk factors for a deep vein thrombosis, it’s fair to wonder if lifting weights with a DVT in one’s lower leg could actually help improve the situation.
On the other hand, it’s equally as compelling to wonder if strength training could make the blood clot worse.
“Our management of DVT is very different now as opposed to several years ago,” says Dr. Moji Gashti, Chief, Division of Vascular Surgery, Department of Surgery, Union Memorial Hospital, Baltimore, MD.
Dr. Gashti continues, “It used to be that these patients would be on bed rest for days before they were allowed to ambulate.”
The irony with that is that excessive bed rest is another risk factor for a DVT.
“These days, however, we have them ambulate right away and carry on with their normal activities.
Lifting Weights with a DVT
“Lifting weights would actually produce a valsalva maneuver, which, if anything, would actually reverse venous blood flow from your lower extremities (towards your feet), and therefore should not cause any problems.”
The valsalva maneuver is practiced by some weightlifters and bodybuilders.
It’s when a person holds their breath while bearing down — like you might do when straining to push out a very hard bowel movement that doesn’t want to exit.
Upon straining to push against resistance at the gym, a person may find themselves bearing down — holding their breath as they strain with the lift rather than exhaling.
However, not all people who lift weights do this; most exhale against the lift.
If you do not employ the valsalva maneuver during your strength training, you should ask your doctor what he thinks about working out with a deep vein thrombosis.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Is Peripheral Vascular Disease Pain Similar to Spinal Stenosis?
Spinal stenosis and PVD (peripheral vascular disease) both cause “leg pain.”
Is there a way to tell the difference between these two conditions?
“The pain from PVD, referred to as intermittent claudication, is very different from pain from spinal stenosis,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
“Peripheral vascular disease typically causes achy, crampy pain in a certain muscle group supplied by a certain artery, most commonly calf muscles, after walking a certain distance,” says Dr. Gashti.
“The hallmark of pain caused by PVD is that it is very reproducible; since the arterial occlusion is a constant, meaning the blockage is there every day, patients complain of experiencing calf pain EVERY TIME they walk from point A to point B.
PVD. National Heart Lung and Blood Institute/Wikimedia Commons
“Pain that presents different than this should raise other possibilities.
“Spinal stenosis causes compression of the nerve roots/spinal cord and typically presents with a burning, or pins and needles kind of pain that may have no relation to walking at all.
“It can occur at rest, while sitting, flat in bed, or walking. It is typically very variable in presentation.”
Spinal stenosis can be confirmed with an MRI.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Beauty Studio
DVT Calve Pain vs. Pulled Calve Muscle Soreness
Can DVT pain in the calve, and the pain of a pulled muscle in the calve, be distinguished?
DVT stands for deep vein thrombosis: a blood clot.
A blood clot in the calve can cause aching or discomfort. So can a pulled or strained muscle in this region.
If there a way to tell the difference between blood clot pain and that which results from a sore or pulled muscle in the calve?
“It is going to be difficult,” says Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
“Both most likely would present with achy kind of pain,” continues Dr. Moji.
“Perhaps the history may be more important here; a pulled muscle most likely would happen with some kind of trauma or activity as opposed to pain related to deep vein thrombosis, which most likely would happen in an individual after some inactivity (post-op, cast, long trips, etc.).
“The pain from DVT most likely would also come about slowly rather than suddenly, and be associated with swelling.”
DVT in lower leg. James Heilman, MD, CreativeCommons
As you can see, a better way to tell the difference between a DVT and a pulled muscle is by evaluating the preceding activity—or lack thereof.
The suspicion for a DVT is heightened if the symptom of what feels like a pulled muscle in one of your calves is accompanied by a redness or warmth in that area, and the discomfort persisting even when you’re seated and not moving the leg.
Another suspicious symptom is that of tenderness to the touch.
Nevertheless, if you suspect a blood clot, head immediately to the emergency room. An ultrasound can make the proper diagnosis.
Dr. Gashti specializes in the diagnosis and treatment of vascular disease including abdominal and aortic aneurysm.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Shutterstock/Shaynepplstockphoto
What Parents Should Know About Concussions: Truth vs. Myths
Concussions are far more common in athletic kids and teens than parents realize, and their child could have had a few concussions without the parents ever knowing.
Many parents continue to be grossly uninformed about concussions. How many parents, for instance, even know that nausea is a sign of a head injury?
The nausea from a concussion can occur hours after the injury, too, but by coincidence, shortly after their teenager ate a lot of French fries and ice cream.
Situations like this could make a parents think that the nausea is from the eating (and it could be), but … a bleed in the brain can produce nausea.
Many kids keep their head bangs a secret, and when they themselves don’t even know that their new-onset symptoms are being caused by a concussion (e.g., drowsiness), this makes it even less likely that the parents will find out what really happened and get medical help.
It’s alarming how uninformed so many parents and others are about concussions.
The myths continue to swirl out there, and not knowing the truth can be deadly.
The following concussion myths and truths come from Chris Hummel, certified athletic trainer and clinical associate professor, Ithaca College’s Department of Exercise and Sport Sciences.
MYTHS
Normal CT scan means no concussion.
Hummel says that a neuro-metabolic event, triggered by trauma, causes a concussion.
This involves chemicals, not brain structure. A CT scan cannot detect chemical imbalance. “CT scans can only view structural damage.”
A concussion is worse if you’re knocked unconscious versus not losing consciousness.
Says Hummel, “In some cases, individuals who are knocked out may suffer less severe trauma.”
He adds that a patient need not lose consciousness to suffer serious injury.
My mother had to have two brain surgeries to drain bleeding and fluid buildup after hitting her head, even though she never lost consciousness.
The harder the impact, the worse the injury.
Hummel says, “Any contact to the head or body that causes rapid head movement can cause a concussion.”
He adds that repeated, lighter impacts over time may be more injurious than one impact of great force.
Helmets will prevent concussions.
Hummel says that helmets are “designed to prevent skull fractures, not concussions.” During impact, the brain still moves like jello while the head is helmeted.
TRUTHS
A history of concussion makes you more likely to experience another.
This isn’t because you’re more likely to continue contact sports; it means that “the threshold for sustaining another concussion can be diminished,” says Hummel.
Beware of second impact syndrome, in which severe trauma or death can result if one suffers a head blow before fully recovered from the first impact.
No two concussions are alike.
Patients should be treated individually rather than cookie-cutter style.
If you suspect a concussion, assume you’re right and proceed to a medical evaluation.
If your gut instinct says head to the emergency room, then do so.
It’s unlikely that one of the regrets you’ll ever have in life is that of spending time waiting around in the emergency room for test results that turned out to be normal.
Nobody kicks himself for having taken the time to get a thorough medical evaluation that turns up negative.
Concussions are a very real problem in youth sports.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Source: sciencedaily.com/releases/2012/03/120329170220.htm
How Does Melanoma Get on the Bottom of a Toe?
It’s true: People have been diagnosed with melanoma on the BOTTOM of a toe–a place that’s almost always in total darkness.
How the heck is this possible?
“Yes, melanoma can exist anywhere,” says Rebecca Baxt, MD, a board certified dermatologist in NJ.
How does melanoma end up on the bottom of a person’s toe?
Dr. Baxt explains, “No one understands it completely. Even where the sun doesn’t shine. There are causes that we don’t fully understand.
“We know that sunburn is a risk factor and that ultraviolet light can cause skin cancer, but we don’t know why these cancers occur all over the body.”
For women, the highest risk area of developing this deadly skin cancer is on the calves and back of the legs, and for men, the highest risk area is the back.
“If it were just about sun exposure, you would think all the skin cancers would be on the face and arms, but that’s not true,” adds Dr. Baxt.
Do skin exams once a month, and check everywhere, including the bottom of your toes, since the “seeds” for melanoma may have been planted during childhood sun exposure to the bottom of your toes while you were playing outside barefoot or lying beside the pool.
How to Check the Feet for Melanoma
Your feet, along with the rest of your skin, should be self-inspected every month for suspicious signs of cancer.
Use a hand mirror and position it under your foot and toes.
If you’re flexible enough, place your foot in the bathroom sink while standing on the other foot.
Place the mirror under your foot and toes. People who practice yoga or martial arts will have no problem doing this.
Don’t hesitate to ask your partner to inspect your feet and under the toes for signs of melanoma which include a dark spot that was never there before, or a pre-existing mole that’s getting bigger or changing shape.
Dr. Baxt
is an assistant clinical professor of dermatology at NYU and a member of the Skin Cancer Foundation. She also specializes in laser treatments, skin rejuvenation procedures, acne treatment and rosacea treatment.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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