Chest Pains and Symptom Medication

Factual Questions
1

First of all, I am not asking for medical advice for myself or anyone I know. This query is just out of curiousity after watching some TV commercials tonight.

A commercial on TV for Cialis, a medication for ED, says in their disclaimer that their products should not be used when taking other medications (nitrates) for chest pain. I have also seen in movies and TV storylines where someone will begin to have some chest pains, possibly angina, and take a pill for it. This is usually done as if taking a Tums to relieve heartburn - as if it is no big deal and the medication is the normal fix for the symptoms.

I always thought that if you were having truly uncomfortable chest pains, that wasn’t heartburn, that you should seek medical attention.

Why is it that some recurring chest pains (that do seem to be heart related) can be expected and simply treated on the spot with medication when they occur, but some chest pains may signal serious problems that need medical attention? What kind of recurring heart problems are simply treated this way? How does someone who has these pains know that they will be treated by their medication or if they are possibly having a heart attack? Doesn’t a recurring heart-related chest pain indicate that something more serious than taking a medication, at the onset of the pain, is required?

I realize I am probably being misled by what I have seen on TV, but it seems to me that taking a pill when having chest pains is something you should do before you call an ambulance. Or do some people handle their heart problems this way simply because they have no insurance or money for proper treatment, and so use the pills as a temporary and cheap fix?

2

I can’t speak for anyone else, of course, but when I have chest pains, it is almost always anxiety-related, and if I need to, I take prescribed medication. Usually, it will pass on its own within ten minutes. I’ve had enough tests to convince me there’s nothing wrong with my heart, in spite of all the times it’s been broken.

If it is not anxiety, it’s refried beans. YMMV

3

I had chest pains (along with shortness of breath and a lot of sweating) a few months ago and the EMTs treated it like a heart attack. It turned out to be a gallstone-related attack of biliary colic. Had I known it was going to pass in about ten minutes, I might not have had someone call 911 for me–but then again, something that severe needs to be assessed. At least now I know what it is and what not to eat to set it off (fingers crossed).

4

Maybe the person who is popping the pill has already seen a doctor and had testing done to determine what is wrong and is taking the medication that is appropriate for her or his condition.

I have known people who had anxiety attacks that mimicked heart attacks and they might experience these two or three times a day.

One night I awoke and thought for sure that I was having a heart attack. I told my husband to call an ambulance. The EMTs said that it was a panic/anxiety attack and they took me to the hospital. It was actually about 200 little bitty gallstones.

If it’s the first time you’ve had a certain pain, you would certainly want to see a doctor. The same is true if there is any doubt. But if the pain is familiar to you and you already know that it is arthritis in a rib joint, why go in every time?

But then, I’m not a doctor.

5

[QUOTE=stanger]

Why is it that some recurring chest pains (that do seem to be heart related) can be expected and simply treated on the spot with medication when they occur, but some chest pains may signal serious problems that need medical attention? What kind of recurring heart problems are simply treated this way? How does someone who has these pains know that they will be treated by their medication or if they are possibly having a heart attack? Doesn’t a recurring heart-related chest pain indicate that something more serious than taking a medication, at the onset of the pain, is required?

I realize I am probably being misled by what I have seen on TV, but it seems to me that taking a pill when having chest pains is something you should do before you call an ambulance. Or do some people handle their heart problems this way simply because they have no insurance or money for proper treatment, and so use the pills as a temporary and cheap fix?
[/QUOTE]

My answer is from a patient’s point of view, as I sometimes have heart-related chest pain. I have a history of heart disease including multiple M.I.'s going back about 20 years. So far, I just guess when it comes to whether chest pain can be addressed with a pill (nitroglycerin) or if I need to call for an ambulance. I don’t guess very well. One rule of thumb I was told was to take 3 nitroglycerine for chest pain; if it didn’t go away, call 911.

One morning, I took 2 nitroglycerine and decided to call 911 anyway. It turned out to be the right thing to do; it was several days before my doctor started thinking I might survive.

I had an incident of angina (chest pain) one day when I was out for a walk, took a nitro pill and left it at that. A week later I was in the hospital, as a subsequent visit to my cardiologist had him convinced that the pain was my 3rd or 4th M.I. So, I suppose my intuition wasn’t so good that time.

A year and a half ago, I had a terrible episode of pain and nitro wasn’t helping, so I called 911. They carted me off to the hospital. A day of testing and I was told I’d experienced something called unstable angina, but had not had an M.I. and I should go home. Another misdiagnosis by the patient.

On the other hand, there were times that I called it correctly and went to the hospital and was told that I was, indeed, dieing. There were episodes of chest pain that were never diagnosed one way or the other, so it’s hard to say whether I’m even getting it right half the time. In reality, it seems like a roll of the dice to me.

6

Many of the erectile dysfunction meds- Viagra (sildenafil), cialis, etc. can potentiate the actions of nitrates which are used to treat angina or cardiac-related chest pain. Nitrates work by causing vasodilation. ED meds can potentiate this drop in blood pressure, which could result in a blood pressure too low to properly perfuse the heart, brain, or other organs. Hence the warning.

Angina is chest pain or discomfort caused by insufficient blood flow to cardiac tissue, and often exacerbated by exercise. It typically lasts only a short time and stops with rest or nitroglycerin. Often times patients with angina will treat themselves with sublingual nitroglycerin. If the pain goes away, they don’t often go to the hospital.

Patients with unstable angina are at much higher risk for heart attack or other cardiac injury.

These people generally require treatment to prevent their condition from worsening to a heart attack and they do need to go to the hospital.

St. Urho
Paramedic