Coronary Artery Disease

When to Call a Doctor

Call911or other emergency services immediately if you have any of the following symptoms:

• Chest pain that has not gone away within 5 minutes after you have taken one nitroglycerin and/or rested. After calling 911, continue to stay on the phone with the emergency operator. He or she will give you further instructions. See how to take nitroglycerin.
• Chest pain or discomfort that is crushing or squeezing, feels like pressure on the chest, and lasts more than 5 minutes, especially if it occurs with any of the following symptoms:
  • Sweating
  • Shortness of breath
  • Nausea or vomiting
  • Pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms
  • Dizziness or lightheadedness
  • Fast or irregular pulse
  • Signs of shock

Women are more likely to have symptoms such as shortness of breath, heartburn, nausea, jaw pain, back pain, or fatigue.

After calling 911 or other emergency services, you should chew 1 regular-strength aspirin (325 mg), if you are not allergic to aspirin or unable to take aspirin for some other reason. By calling 911 and taking an ambulance to the hospital, you may be able to start treatment before you arrive at the hospital. If any complications occur along the way, ambulance personnel are trained to evaluate and treat them.

If an ambulance is not readily available, have someone else drive you to the emergency room. Do not drive yourself to the hospital.

If you witness a person becoming unconscious, call 911 or other emergency services and start cardiopulmonary resuscitation (CPR). The emergency operator can coach you on how to perform CPR. For more information, see the CPR section in the topic Dealing With Emergencies.

You should contact your doctor immediately if you have new, more frequent, or severe episodes of chest pain or discomfort, which may indicate you have an increased risk for a heart attack.

Talk to your doctor if you have:

• Chest pain or discomfort for the first time with features similar to those of coronary artery disease (CAD) (see the Symptoms section of this topic).
• Episodes of chest pain or discomfort and your work involves responsibility for the lives of other people (such as a pilot, bus driver, or sole caregiver for small children).

Treat symptoms as early as possible to help prevent permanent damage to your heart. Chest pain and shortness of breath are more likely to be serious and related to your heart if:

• They are like previous symptoms you have had due to coronary artery disease
• You have one or more risk factors for coronary artery disease.

The following are clues that your chest pain is less likely to be caused by a heart problem:

• You have pinpointed pain (you can point to the exact spot that hurts).
• The pain gets worse when you take a deep breath, or holding your breath for a few seconds reduces the pain significantly.
• The pain is related to moving or pressing on a specific part of the chest wall, neck, or shoulder.
• Antacids dramatically relieve the pain.
• The pain lasts only a few seconds. This is unlikely to be caused by a problem with your heart.

If any type of chest pain continues, it needs to be evaluated by a doctor. Because many vital organs are found in the chest, even chest pain that is not caused by coronary artery disease may be a sign of a serious problem in the aorta (the large blood vessel that leads out of the heart), lungs, or digestive organs.

Never wait if you have symptoms of a heart attack

Many people are unsure whether they are having a heart attack and so they take a "wait and see" approach. Heart attack symptoms often vary. People often discount their symptoms if they do not fit into the expected "extreme chest pain" scenario. Some people are embarrassed or don't want to bother others by calling for help if they think it may not be a heart attack. Even if you're not sure it's a heart attack, you should still have it checked out. Rapid treatment can save your life.

Who to See

To see whether you are at risk for heart disease, have symptoms of coronary artery disease, or require long-term care for existing heart disease, see your family doctor or internist. For diagnosis of coronary artery disease, you may see a cardiologist. For ongoing care of stable angina, you will likely see your family doctor or an internist. For surgical intervention, you will be referred to a cardiovascular surgeon.

More Information: Which health professionals can help me once I've been diagnosed with coronary artery disease?

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Author:	Robin Parks, MS	Last Updated: January 8, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition
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