I was checking on my patients in the cardiac monitoring unit at the hospital where I am on staff, when Denise, a 31-year-old nurse on the unit, stopped me to ask about chest pains she was having.
“I think I need to come see you,” she said. Denise had been my patient for several years. “I’ve been having these pains off and on. It’s been more than a month, and they’re not going away.”
Denise was clenching her fist over her mid-chest—a signal that, despite her relatively young age, she might be experiencing cardiac pain. Patients describing angina, the major symptom of a heart starved for oxygen because of narrowed coronary arteries, often clench their fist against their chest to illustrate what they’re feeling. Typical angina is a pressure-like pain felt in the middle of the chest that is brought on by physical exertion. It fades away with rest. The ache may radiate into the neck or jaw or down an arm.
But Denise’s chest pain was not typical of angina. Her pains were occurring at random times, unprovoked by anything she could identify. And the discomfort went away spontaneously after several minutes, whether she stopped what she was doing or not. Exercise didn’t bother her at all, she said. As I eyed her overweight frame, however—she was an even five feet tall and weighed 150 pounds—it struck me that serious exercise was something she probably thought about more than she actually did.
