Not indigestion, a heart attack

According to Budd, his symptoms started at least a day before he felt any chest pain. He'd become winded and sweaty after carrying some boxes up and down steps. Then, he felt pain in his shoulder, neck, and back later that day and woke up twice during the night sweating.

Budd assumed his problems were related to a stomach bug, since he'd thrown up twice the day before. But then he started feeling pressure in his chest, "like a weight was pressed against my ribs, or my chest was overinflated with air."

Remembering that his father had died of a heart attack years before, Budd decided to call a friend to take him to the ED. Within an hour of arriving, a cardiologist looked at an electrocardiogram of his heart, diagnosed a blockage in a coronary artery leading to the heart, and had Budd rushed by helicopter to a hospital with a cardiac catheterization lab.

After doctors put a catheter through his arm into his heart, they didn't find any blockage, and guessed that a piece of plaque had ruptured and clotted an artery and then passed on its own.

Now, after finishing cardiac rehab, Budd writes that he has "an excellent long-term prognosis."

What Budd learned from his experience

Chest pain is the most commonly known symptom of a heart attack, but Budd writes that upper body pain is also a common, lesser-known symptom.

"Anything between the belly button and the forehead could be a heart-related symptom," said Donald Lloyd-Jones, a cardiologist, immediate past president of the American Heart Association and chair of the department of preventive medicine at Northwestern University's Feinberg School of Medicine.

"The classic symptom is that elephant sitting on the middle of your chest — this heavy, crushing pressure, mid-chest," Lloyd-Jones said. "Never ignore that. It's the most common warning sign."

Other potential warning signs include arm pain, stomach pain, and pain in your gums or jaw. If that pain is accompanied by other symptoms like sweating, shortness of breath, lightheadedness, or feeling faint, Budd writes you should consider calling 911.

Also, "If the symptoms seem more common with exertion and they're better when you rest, that's a red flag for any doctor to say, 'Let's get you in and see what's going on,'" Lloyd-Jones added.

It's also possible for symptoms to appear "hours, days, or weeks in advance" of a heart attack, according to the Mayo Clinic.

"Most people will say, 'You know, a couple days ago, I wasn't feeling good, I had indigestion' — there's usually something that's not right," said Alan Schneider, a cardiologist and electrophysiologist at Suburban Hospital. "It doesn't have to be crushing pain."

Budd also notes that he made a mistake by asking a friend to drive him to the ED, rather than calling 911. "If my heart had stopped during the drive, EMTs could have treated me immediately," Budd writes. "They have a defibrillator to restart a heart, an EKG machine to test your heart rhythm, lifesaving medications, and they know which hospitals have the right facilities to treat a heart problem."

In fact, research by Atlantic Health System found that heart attack patients who called 911 received treatment 30 minutes faster than those who drove themselves.

"You want EMTs monitoring you all the way," Lloyd-Jones said. "If something happens, they can respond instantaneously." (Budd, Washington Post, 6/11)

COVID-19  exposed several gaps in what was once considered the “norm” of cardiovascular care. While the pandemic has accelerated out-of-hospital shift, exacerbated workforce competition and slowed the launch of new federal, risk-based programs, it has also increased cross-industry interest in retail care models, value-based payment, virtual and home-based care, and equity initiatives that are both mission- and business-driven. These shifting dynamics introduce not only new challenges but also new opportunities for CV leaders. Download the report to learn about four key drivers reshaping the delivery of care for patients with cardiovascular diseases, such as altered referral patterns, and more.