By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Denial Can Be Deadly… According to the dictionary, denial, psychologically-speaking, means “a condition in which someone will not admit that something sad, painful, etc., is true or real.”
In cardiology, denial refers to a fairly common habit among patients to not admit that they have a heart problem. Such denial can be deadly! Know how to recognize these symptoms of a heart attack…
Heart Attack Symptoms You Should Never Ignore
Whether you are male or female, and regardless of your age, be aware of these heart attack symptoms and whether they are persistent or come and go:
- Chest pains, mild or severe.
- Shortness of breath, with or without chest pain.
- Radiation of discomfort into the neck, arm, or jaw.
- Accompanying sweating.
- Anxiety / sense of doom.
If you develop two or more of these symptoms, whether mild or severe, and they don’t improve in five minutes, do not try to rationalize and self-diagnose your situation. Go to the nearest emergency room as soon as possible. It’s as simple as dialing 9-1-1.
Additional symptoms that may occur:
- Light-headedness / dizziness
- Rapid / irregular pulse
- Fatigue / weakness
- Nausea / vomiting
- Feeling of having to burp
Heart Attack Symptoms In Women May Differ
Women often experience different heart attack symptoms than men do, and most medical professionals are trained to recognize the symptoms that usually occur in men. Learn to recognize symptoms of heart disease in women.
What’s Your Cardiac Risk?
I developed this general questionnaire to help you determine how at risk of heart disease and a heart attack you may be based on your lifestyle practices. While it’s no substitute for a doctor’s visit, taking it can help you and your doctor assess your risk of cardiovascular disease.
Denial Is a Cardiovascular Risk Factor
Individuals who deny they have a medical emergency are jeopardizing not only their health but their very life as well. Over the years, many patients, even those experiencing severe chest and arm pain, would try to minimize their situation, saying they had something else other than a heart condition. Often I treated these deniers for serious heart attacks.
You might think that such kind of denial is a macho thing. It’s not. Both genders fall into the denial trap. I vividly recall the case of a woman in her fifties who developed chest pain while hosting a dinner party. The pain had risen up to her jaw. She postponed going to the emergency room until hours later, at 1 a.m., after her final guest had departed. She had a massive heart attack and almost died in the emergency room. Later she told me she didn’t think she could possibly have a heart problem. Women, research indicates, often delay seeking help because they think heart disease is a male problem and they prefer to self-medicate. The fact is that more women than men die of heart attacks.
Whether you are a man or a woman, denial of heart attack symptoms is absolutely a cardiovascular risk factor. I have treated hundreds of patients in total denial, not only of their symptoms of heart disease, but even of heart damage itself.
In cardiology today, such denial is regarded seriously because when deniers delay or refuse to seek medical care, they lose out on the benefits (including lower mortality rates) achieved by recent advances in treatment. The American Heart Association has waged public education campaigns for years emphasizing that about half of all heart attack deaths occur within one hour after symptoms appear and usually outside the hospital. Outcomes are clearly optimized when care is obtained during that first hour after symptom onset. Many deniers receive care significantly later.
In a 2010 Mayo Clinic study involving more than 100,000 patients with a relatively mild form of heart attack in which a blood clot doesn’t totally occlude a particular coronary artery, researchers found that the average patient came to the hospital about 2 ½ hours after first feeling the symptoms. Eleven percent of the patients waited 12 or more hours before putting in a 9-1-1 call or getting to the hospital. Seniors, women, nonwhites, smokers, and diabetics tended to delay the most.
In a Swedish study of first time heart attacks, involving 78 men and 29 women, researchers monitored whether the patients sought help within or beyond four hours, and also whether they attended a follow-up rehabilitation program. The results: 49 patients procrastinated and 76 failed to participate in rehab. The researchers interviewed all patients and found that “high deniers” were both delayers and non-attenders.
Years ago people were reluctant to come into the emergency room even with chest pain. Thanks to the advent of thrombolytic (clot busters) and stent (angioplasty) therapy, there has been a huge advance in treatment and survival. The earlier you get in the faster you get blood flow revived and the better the survival.
My mantra, for decades, has been “prevention is easier than cure.” Your lifestyle habits can greatly impact your health, especially that of your ticker. Awareness is key…Once you learn about lifestyle habits that can make or break your heart-health, you can consciously choose to live healthfully each day. These sections, here at HeartMD, are a great place to start:
- Covino JM, et al. Denial of cardiac illness: Consequences and management. Primary Care Companion CNS Disorders, 2011;13(5).
- Dracup K., et al. Causes of delay in seeking treatment for heart attack symptoms. Soc Sci Med, 1995;40(3):379–392.
- Higginson R. Women’s help-seeking behavior at the onset of myocardial infarction. Br J Nurs, 2008;17(1):10-14.
- Perkins-Porras L, et al. Causal beliefs, cardiac denial and pre-hospital delays following the onset of acute coronary syndromes. J Behav Med. 2008;31(6):498-505.
- Stenstrom U, et al. Denial in patients with a first-time myocardial infarction: relations to pre-hospital delay and attendance to a cardiac rehabilitation programme. Eur J Cardiovasc Prev Rehabil, 2005;12(6):568-71.
- Ting HH, et al. Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction. Arch Intern Med, 2010;170(20):1834-41.
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