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February 2011

February is Heart Health Month at Simplicity Urgent Care

According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the United States. About every 25 seconds, an American will have a coronary event. Nearly every minute, someone will die from it. In 2010, an estimated 785,000 Americans had a heart attack, and 470,000 had a recurrent attack.

As ER doctors, we know the chance of developing coronary heart disease can be reduced by taking steps to prevent and control the factors that put you and your loved ones at risk. That’s why knowing the signs and symptoms of heart attack are crucial to the most positive outcomes.

Below, Dr. Maguire shares information on the warning signs — which are different for women and diabetics than they are for men, and what to do in the event of an attack (call 911 or head to the Emergency Room).

From all of us at Simplicity Urgent Care, here’s to your good health.Drs. John Jones and John Maguire, owners,

How to Deal With Heart Pain

By Dr. John Maguire

Chest pain is one of the most common complaints we see in the emergency departments that I manage here in Northern Virginia. Typically, the patient looks up at me with big, scared eyes and asks, “Am I having a heart attack?”

I always wish that it were easier to tell, but despite medical advances, we are still usually unable to answer the question at the time of that initial visit.

Here’s why:

1. Chest pain is a very difficult symptom to pin a diagnosis to because it can be a sign of several other problems, including a broken rib, a blood clot, pneumonia, or a tear in the aorta, among other conditions.

2. That is why most physicians make a diagnosis based on the patient’s medical history. For instance, we know that if the patient smokes, has high cholesterol, and has a family history of heart disease, he or she is more likely to have a heart problem than the healthy triathlete.

3. Physicians are trained to create a differential diagnosis, which is a list of the possibilities that could be the cause of the symptoms. With chest pain as the presenting complaint, we care less about making a diagnosis and more about ruling out something that is life threatening.

Two groups of patients commonly have unusual symptoms when they are actually having a heart attack:

Women: Heart disease is a big threat to women’s health. Believe it or not, statistics show that about 267,000 women die of heart attacks each year — six times more than those who die of breast cancer. The reason it’s such a big threat is that women who are having a heart attack often have atypical complaints, such as shortness of breath, nausea and / or vomiting, and back or jaw pain. They also experience flu-like symptoms, fatigue, extreme weakness, light-headedness, and cold sweats.

In addition, women tend to be about 10 years older than men when they have a heart attack. About 82 percent are 55 or older. They also tend to have high blood pressure, high cholesterol, and / or diabetes (see more on that below). And they are likely to be smokers, overweight, and lead a sedentary lifestyle. Unfortunately, women are often less likely than men to believe they’re having a heart attack, so they delay seeking emergency treatment. Obviously, this is a lethal combination and one that needs to be paid more attention to.

Diabetics: Another group of patients that have atypical complaints when they are having a heart attack is diabetics. Usually, they do not have chest pain, but complain of significant nausea. That is why physicians must be masters of pattern recognition, and be able to see outside the “normal” patterns to minimize the possibility of missing the tough case.

Signs of a heart attack:

  • Pressure, fullness, or tightness in your chest
  • Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and arms, especially your left arm
  • Pain that lasts more than a few minutes, goes away and comes back, or varies in intensity
  • Shortness of breath, sweating, dizziness, or nausea
  • Chest pain related to noncardiac problems

Chest pain that isn’t related to a heart problem is more often associated with:

  • A burning sensation behind your breastbone (sternum)
  • A sour taste or a sensation of food re-entering your mouth
  • Trouble swallowing
  • Pain that gets better or worse when you change your body position
  • Pain that intensifies when you breathe deeply or cough
  • Tenderness when you push on your chest

If you think you are having a heart attack:

1. Call 911 and the EMTs will take you to the nearest Emergency Department. While urgent care centers are great for a lot of things, the ED is where you want to be if you are having a heart attack. Please do not drive yourself to the hospital, unless you have no other choice, as your condition could worsen and you risk putting yourself and other drivers in danger.

2. Once at the ER or urgent care center, explain the problem and expect to be seen immediately.

3. In most cases, an EKG will be conducted quickly. This recording of the electrical activity in your heart is the first screen for heart attack. It also identifies patients who need to have other heart-related procedures done, including an angioplasty, where the clogged blood vessel is opened with a balloon.

4. Unfortunately, a relatively small percentage of patients have no EKG changes when they are having a heart attack or angina. So an EKG is not always helpful. That is why doctors will also ask to draw blood to look for cardiac enzymes, which improves the possibility that we will quickly identify the problem.

Questions? Contact Dr. Maguire at by email.

Next Month’s Feature: Dr. Salma Haque on Headaches

In our March newsletter, Simplicity Urgent Care physician Dr. Salma Haque will be talking about headaches — what causes them, when to worry, and how to treat them when they occur (or reoccur).

In this issue, we wanted to take the opportunity to introduce you to Dr. Haque.

A physician at Simplicity Urgent Care, she is certified by the American Board of Internal Medicine and completed her training at Georgetown University / Washington Hospital Center in Washington, D.C., in internal medicine.

She graduated from Illinois Institute of Technology with a BS in Chemical Engineering and then completed her medical degree from Louisiana State University Medical School.

Dr. Haque’s areas of interest include kidney related disorders and preventative management of diabetes. She enjoys the wide range of patients and the ability to offer immediate attention to patients at Simplicity Urgent Care.

She is originally from Baton Rouge, Louisiana, and now resides in the DC area.

Contact Dr. Haque by email.