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All chest-related symptoms should be red flags

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For more than three years, Donna Tronvig of Maple Valley visited doctors to determine just what was causing a persistent burning sensation in her chest. The pain was enough at times to make her stop for rest between the car and grocery store door.

"I saw a bunch of doctors and all them said I was fine, that nothing was wrong," said Tronvig, during a work break from her job in the floral department at a Safeway supermarket in Issaquah.

Tronvig started with a cardiologist. Makes sense. Burning sensation in the chest. Not the classic squeezing-pressure chest pain but, hey, the heart's in that region.

The cardiologist put Tronvig through a stress test. She passed with flying colors.

"I figured I was heart-healthy," recalled Tronvig.

Next she consulted internists and digestive specialists. She saw a lung specialist. The only diagnosis was severe heartburn. She took high-strength heartburn medication that did nothing to alleviate the burning.

On Oct. 8, 2001, Tronvig felt so lousy that her husband, Richard, refused to go to work that day. Instead he vowed to help his wife "get to the bottom of this." The Maple Valley couple drove to the emergency room at the University of Washington Medical Center.

It was Tronvig's fortune that Dr. Larry Dean, director of the UW Medicine Regional Heart Center, was on call that day. He examined Tronvig, listened to her story and decided she might be suffering from cardiovascular disease. Dean looked past the fact that Tronvig was only 43 and did well on a stress test.

"My litmus test is if someone is sick enough to go to the emergency room," Dean said, "then I will look at every possibility about why that person is suffering."

Dean ordered some blood tests and asked Tronvig to stay in the ER's observation area. The tests prompted him to order an angioplasty procedure that uses dyes injected in the blood to determine any heart blockage.

"It was a Thursday," said Tronvig. "The procedure showed significant blockage. The doctors wouldn't let me go home. I had surgery (triple bypass) on Monday."

Tronvig doesn't regret the lost weekend. She says she is feeling great and that six-month checkups with Dean continue to be only good news.

"I got lucky," says Tronvig, a mother of two high-schoolers and one college student. "I was close to having a heart attack or not being here at all."

Tronvig said her age and apparent healthy appearance worked against her. Doctors just looked past heart disease as the cause. A study published this month in the medical journal Chest adds fuel to Tronvig's position -- or that of any woman who has encountered disbelief that a female might be suffering a heart attack or require cardio attention.

The study showed heart attack patients who do not have chest pains are up to three times more likely to die of the illness, probably because doctors do not recognize their symptoms. An estimated 13 percent of patients without chest pain died in the hospital, compared to 4.3 percent of patients with chest pain, said researchers at Concord Hospital in Sydney, Australia.

Patients without chest pain tended to be older women with diabetes, heart failure or high blood pressure. Patients who suffered chest pain were more likely to be smokers with clogged arteries.

Less common but still potentially deadly heart attack symptoms include fainting, shortness of breath, excessive sweating or nausea and vomiting. Any sudden, rapid or unexplained changes related to these symptoms are considered health red flags, said Dean.

Some of the same symptoms can be attached to a flu bug. Dean's test of traveling to the ER is a good starting point. If you feel that terrible and you are willing to tolerate the discomforts of the trip, you likely are better off erring on the side of caution, going to the ER and finding out what's happening.

Dean said doctors are learning more about enzymes that leak from the heart into the blood during cardiac episodes. If a patient tests positive for these enzymes, such as troponin -- which don't last long in the bloodstream and sometimes require 12 to 24 hours of ER observation before appearing -- then he treats the patient as aggressively as someone with the hammer-squeeze chest pains we all associate with heart attacks.

The ER observation that Dean mentioned is more likely to occur at larger medical centers and hospitals. Others might not have the budget or staff to keep patients under observation.

"One message of this study is people treated less aggressively for heart disease don't do well," said Dean. "Doctors have a growing awareness of women's heart disease, but it is important to keep getting the word out."

Understanding that squeezing chest pain is just one symptom, and less common among women, is a good start.

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