Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Early Warning For Atypical Chest Pain

There is an article[1] in yesterday’s newspaper about an early warning for chest pain. There is also a video with better explanations of the device.[2]

Why would anyone need an early warning for chest pain?

Not all chest pain is the typical crushing feeling over the middle of the chest. Actually, the chest pain considered to be typical may be the atypical presentation.

We may be doing people a disservice by convincing them that the atypical presentation is unusual. Typical chest pain is the kind of experience that is almost impossible to ignore. Anything that feels as if your chest is being crushed, is going to be difficult to ignore . . .

Difficult to ignore?

OK. It is impossible to ignore, but it is difficult to rationalize as something other than cardiac chest pain. Maybe this should be described as Typical Male Chest Pain. This isn’t about being politically correct, but women are much more likely to experience heart attacks without the typical crushing chest pain, than men.

However, the other presentations of an Acute Coronary Syndrome (ACS), or what people generally call a heart attack, can be much easier to explain as something that is not a heart attack.

I’m only 80. It can’t be a heart attack!

That is true. It does not matter what the age is. 60, 50, 40, 30, or anything else. I have worked teen-aged cardiac arrest patients that had cardiac causes for their cardiac arrest. While the lower you go in age, the less likely that you are dealing with a heart attack, there is no age at which we are immune from heart attacks.

What are the so-called atypical presentations of chest pain?

Indigestion. If there is one thing that is easy to excuse as something other than chest pain, indigestion is that thing. I just ate too much; or I ate something that didn’t agree with me; or I’m upset about whatever; or My reflux is acting up; or any of a dozen other explanations.

Difficulty breathing. Clearly difficulty breathing is a breathing problem, right? Wrong. If the heart is not working effectively to deliver blood to a part of the heart having a heart attack, the heart may be perceiving the problem as a lack of air – difficulty breathing.

Maybe if I just skip to the sidebar of the article:

Symptoms for men:

Chest discomfort lasting for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.

Discomfort in other areas of the upper body, such as one or both arms, the back, neck, jaw, or stomach.

Shortness of breath.

Other symptoms may include breaking out in a cold sweat, nausea or light-headedness.

Symptoms for women:

Unusual fatigue.


Pain in either arm.



They don’t even include chest pain in the symptoms for women. There is a bunch of research on prodromal symptoms of heart attack. Perhaps this device will be able to pick up on some of what is otherwise dismissed as not feeling up to par. If these prodromal symptoms are reflected in the ECG, and th device, the Guardian System, is able to pick up on those ECG changes, that could make a big difference in outcomes from heart attacks. Those are some pretty big If’s, but this is definitely worth investigating.

In the video, Nick Nudell shows the device and explains the way it works. Nick is frequently on the EMS Garage and one of the founders of the EKG Club (along with Tom B. of Prehospital 12 Lead ECG). There is a doctor explaining things, too, but they did focus on Nick.

AngelMed has a page with some links to further information, here.


^ 1 Device to warn of heart problems tested at Memorial
By Phillip Zonkel, Staff Writer
Posted: 09/16/2009 08:53:34 PM PDT

^ 2 Long Beach Memorial Successfully Implants Cutting-Edge Heart Attack Detection Device
YouTube video of the news broadcast

From the more information section at YouTube:

MemorialCare Heart and Vascular Institute at Long Beach Memorial Medical Center (LBMMC) successfully implanted a new, cutting-edge heart attack detection device in two heart attack survivors. With the danger of a second heart attack occurring in the first year for 35 percent of female survivors and 20 percent of male survivors, the device is designed to monitor and analyze data about a patients heart, reducing the time it takes to get to the emergency room.

^ 3 Device to warn of heart problems tested at Memorial
By Phillip Zonkel, Staff Writer
Posted: 09/16/2009 08:53:34 PM PDT
This is the same as footnote [1].