Can a Heart Attack Occur Without Chest Pain?

How many times have you seen this act on TV? The character on the screen gets a glazed look in his eyes, stumbles, and clutches his chest as he slowly (and dramatically) falls to the ground. This is the classic Hollywood depiction of a heart attack. And while this scenario might accurately describe some heart attacks, it's not representative. In fact, the notion that severe chest pain must indicate a heart attack, or a heart attack must come with severe chest pain, is not always true.

A recent study published in the Annals of Internal Medicine reports that chest pain severity is not an indicator of who is having, or is likely to have, a heart attack. Patient history and cardiovascular risk factors are better indicators than pain score.

What is a heart attack?

When a blockage limits the supply of blood and oxygen to the heart, it can cause a heart attack, or myocardial infarction. Clots develop when fat and other substances accumulate in the coronary artery, which supplies crucial blood and oxygen to the heart. If not treated right away, damaged heart muscles can die.

Symptoms of a heart attack

Chest pain is the number one reason people visit the emergency room and the most common heart attack symptom. The pain can be severe, but can just as likely start slowly as mild pain or discomfort; it may even come and go. When severe, patients describe it as a crushing or searing pain that radiates to the back, neck, jaw, shoulders and arms, especially the left arm. The researchers in this new study believe the brain may interpret signals from the heart as pain located elsewhere, or as other health problems caused by a damaged heart.

Heart attacks are the leading cause of death in the U.S. They do not discriminate, and women are just as likely to have a heart attack as men are. While chest pain may not indicate a heart attack, it is a sign that something is wrong. You should seek immediate emergency medical care in case you are having a heart attack. About half the deaths from heart attacks occur within an hour of the start of symptoms and before people reach the hospital. Time is of the essence.

Be aware of the other symptoms of heart attacks as well. In addition to chest pain, patients may experience shortness of breath, nausea, vomiting, faintness, sweating, dizziness, or unexplained pain that's not in the chest.

Sources:

Busko, Marlene. " Chest Pain Severity Not a Telltale Sign for MI." Medscape Medical News. Web. 29 July 2011. http://www.medscape.com/viewarticle/748240

Mayo Clinic. "Chest pain." Web. 11 February 2011.
http://www.mayoclinic.com/health/chest-pain/DS00016

National Heart, Lung and Blood Institute. "Heart Attacks." Web.
http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm

Emotional Benefits of Being a Working Mom

Several recent studies have demonstrated that working, especially part time, provides mental health benefits for women.

A study in the December 2011 issue of the Journal of Family Psychology examined several aspects of well being in mothers who worked part time compared to those who worked full time or not at all. The researchers found that there was little data about this particular category of working mothers (defined as working up to 32 hours per week), particularly through their children's middle childhood. However, up to 25 percent of all women work part time and most will eventually work at least part time.

They found that part-time employment has distinct positive associations with mothers' psychosocial well being and with how they perceive work-family conflicts, although the patterns vary by children's developmental periods and for particular aspects of family life. Part-time working mothers are more likely to report overall better health and fewer work-family conflicts, and less likely to report depressive symptoms. They were also more likely to be engaged in their children's schooling and provide learning experiences for their children.

A December 2011 issue of Time described a study of 1,600 working and stay-at-home moms that found employed women had better mental health status as long as they had realistic expectations of what they could reasonably accomplish and rejected the idea they could be a supermom. Not surprisingly, performing enjoyable work was a contributing factor to positive mental health status.

According to writer Sara Sutton Fell, working at least part time helps mothers develop patience with their kids and teach children that hard work-and working hard-are good. Children of working moms learn to respect women as equals, and retaining a professional career allows women to contribute financially to their kids' well being and future. Employers should recognize part-time work as both a legitimate career approach and a key ingredient to maintaining healthy family lives.

Thanks to the Family and Medical Leave Act of 1993 (FMLA), the government recognizes the importance of facilitating working parents' ability to participate in early childrearing. The Act prohibits employer discrimination based on gender and reinforces the importance of mothers (and fathers) balancing demands of the workplace with needs of the family.

Sources:

Buehler, Cheryl and O'Brien, Marion. "Mothers' Part-Time Employment: Associations With Mother and Family Well-Being." Journal of Family Psychology 25 (6) (2011): 895-906. Web. http://www.apa.org/pubs/journals/releases/fam-25-6-895.pdf

Rochman, Bonnie. "Working Women Who Try to Be 'Supermom' May Be More Depressed." Time. Web. 23 August 2011.http://healthland.time.com/2011/08/23/working-women-who-subscribe-to-the-supermom-myth-are-more-likely-to-be-depressed/#ixzz1iy4XDP1h

Fell, Sara Sutton. "4 Benefits of Being a Working Mom." Flexjobs.com. Web. 14 July 2011.

http://www.flexjobs.com/blog/post/4-benefits-of-being-a-working-mom/

Poduval, Jayita and Poduval, Murali. "Working Mothers: How Much Working, How Much Mothers, And Where Is The Womanhood?" The Mens Sana Monographs 7 (1) (2009): 63 - 79. Web.

http://www.msmonographs.org/article.asp?issn=0973-1229;year=2009;volume=7;issue=1;spage=63;epage=79;aulast=Poduval

Can Talk Therapy Provide Pain Relief?

Could talking it out help relieve your pain? According to recent studies, it might. It might also make living with chronic pain less challenging and debilitating.

Pain is a subjective sensation that's experienced both in your head and in your body. Your brain incorporates your mood, state of health, anxiety level and other emotional components while processing pain sensations and transmitting messages about how to handle it. Since pain is processed along many of the same neural pathways the brain uses to process emotions and mood that may increase how much pain we feel. A study conducted by researchers at the University of Oxford demonstrated that when people are depressed or feeling sad, they experience more pain than when they're feeling upbeat. The authors speculated that a sad emotional state disables our ability to regulate negative emotions associated with feeling pain, which may make the pain feel worse.  

Other studies demonstrate that talk therapy, both in-person and over the phone, are effective in dramatically reducing  chronic pain. Cognitive behavioral therapy is particularly successful because it teaches patients to recognize the way they think about their pain, change their thoughts and behaviors associated with it and observe how those changes impact their pain level. Patients who participated in studies that utilized cognitive behavioral therapy reported dramatic improvements that were not reported by patients using traditional medical treatments.

Patients who live with chronic pain have unique emotional challenges and increased stressors that healthier people do not experience. Chronic pain can cause sleep deprivation, low self-esteem, anxiety, make performing daily tasks and maintaining a job difficult, alter relationships and cause isolation.  It's no wonder then that 25-50 percent of pain patients report depression and 65 percent of depressed patients report pain. 

Many pain management clinics incorporate individual and group therapy into their patients' care plans to help strategize coping techniques and deal with the emotional impact of living with pain. Patients report that this type of emotional support improves their quality of life and makes the challenges of living with chronic pain more manageable. 

If you have a chronic pain condition, talk with your doctor about your risks for depression and ask for recommendations for therapists with experience treating pain patients.

Sources:

Induction of Depressed Mood Disrupts Emotion Regulation Neurocircuitry and Enhances Pain Unpleasantness.

Biological Psychiatry, 2010; 67 (11): 1083

Chantal Berna, Siri Leknes, Emily A. Holmes, Robert R. Edwards, Guy M. Goodwin, Irene Tracey.   

Johns Hopkins Arthritis Center

Managing Chronic Pain, Depression & Antidepressants: 
Issues & Relationships

Michael Clark, M.D., M.P.H.

http://www.hopkins-arthritis.org/patient-corner/disease-management/depression.html