When the heart sends a signal

Risposta: Chest pain is certainly a symptom that should not be underestimated, especially when it is triggered by physical exertion or strong emotions, or when the pain is accompanied by a cold sweat, nausea or difficulty breathing. In such cases, you must call 112 or 118, as severe chest pain accompanied by the aforementioned autonomic symptoms could indicate an acute myocardial infarction. In such cases, calling the emergency numbers activates a genuine ‘fast track’ procedure, enabling the emergency services to take the patient directly to the cardiac catheterisation laboratory, where life-saving angioplasty can be performed very quickly. Conversely, it has been clearly demonstrated that travelling to A&E by one’s own means results in a significant delay in coronary reperfusion, leading to a worse prognosis. The typical pain associated with coronary syndrome is characterised by a sensation of heaviness or tightness across the chest or behind the breastbone, which may radiate to the neck, down the left arm to the hand and, in particular, to the last two fingers. It may also radiate to the corners of the jaw, the epigastrium or the back. This pain does not change with breathing. If the pain caused by ischaemic heart disease is due to a temporary reduction in coronary blood flow, it is referred to as angina, and such pain lasts between 5 and 30 minutes. In the case of a myocardial infarction, the reduction or cessation of blood flow is persistent, and the duration exceeds 30 minutes. Conversely, pain that worsens with deep inhalation or when lying on one’s back (supine) should raise suspicion of pericarditis, i.e. inflammation of the layers lining the heart. Symptoms that, however, should not cause concern, as they are not caused by heart conditions, include a ‘stabbing pain’ in the chest – that is, a very brief, piercing pain, usually lasting about a second, localised to a small area of the chest. This type of pain is generally more common in people suffering from anxiety-related disorders. As well as the pain, it is important to pay attention to your ability to carry out normal daily activities: the onset of unexpected shortness of breath or an abnormally ‘rapid’ heartbeat relative to the tasks being performed requires consultation with your GP. In the latter case, it will be necessary to rule out incipient heart failure, which is often accompanied by the typical sign of oedema in the lower limbs. More rarely, the inability to carry out normal activities of daily living may be secondary to a pathological slowing of the heart rate due to diseases of the cardiac conduction system. Conversely, the heart may suddenly accelerate for no apparent reason; if this acceleration is abrupt and the heart rate returns to normal just as suddenly, it is likely to be an arrhythmia warranting further investigation by a cardiologist. Conversely, when the increase in heart rate and the return to normal are gradual, it is more likely to be physiological sinus tachycardia secondary to exertion, emotions or anxiety. Another specific type of palpitations is where the heartbeat feels fast but irregular; in this case, it could be atrial fibrillation. You feel as though your heart is out of control, with a rapid and chaotic rhythm, often accompanied by shortness of breath. This sensation warrants a medical check-up, as it is essential to initiate the most appropriate treatment as soon as possible.

Finally, a temporary loss of consciousness, known as syncope, must always be assessed in order to determine its cause. When it occurs after prolonged standing, particularly in a hot environment, or after passing urine, or after suddenly standing up, it may be secondary to a problem with the mechanisms regulating blood pressure and is usually benign. Conversely, if it occurs during movement, exertion, or whilst sitting or lying down, immediate medical attention is required, as it may be caused by life-threatening conditions.