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Just had a heart attack
301 points by mindcrime on Nov 3, 2014 | hide | past | favorite | 213 comments
In the ICU at UNC hospital in chapel hill. Had emergency surgery and it looks like I'll be OK.

Wish I had some deep insights to share as a result but right now all I can really say is

"If you start feeling chest pains, don't hesitate to call 911. If I'd waited much longer I probably wouldn't be here to send this. Learn the warning signs and call 911 if in doubt."




Can someone with some medical experience write about what are exactly the warning signs for a heart attack?

While it's definitely wise to call 911 when in doubt, it's good to have own understanding first so we don't ignore the symptoms AND don't flood 911 with false problems.


Doctor here. The 'typical' signs of a heart attack are chest pain usually described as dull, heavy or tight, with radiation to the arm(s) and neck. The patient often also complains of diaphoresis (sweating) , shortness of breath and perhaps weakness.

'Typical' signs do not present in everyone: in particular diabetics are at increased risk of having 'silent' heart attacks, And chest pain that is not typical may also be a heart attack.

An ECG can rapidly demonstrate that a patient is having a heart attack or as we call them myocardial infarcts, and excellent intervention is often possible.

If the above condition/pain is experienced and there is not a clear ECG picture of a heart attack troponin levels are taken at 6 hrs, an increase f which will demonstrate that there was cardiac specific muscle damage.

Without wanting to alarm anyone, there is in the US 250,000 sudden cardiac deaths a year, almost all from a coronary artery called the left main blocking: this vessel supplies a huge percentage of the heart muscle and when it blocks there is no warning and the heart doesn't have enough fuel to keep pumping.. These patients unfortunately almost all dead on arrival. There is very little that can be done to predict this as their first episode of chest pain usually results in death within minutes, and there are rarely indications that the patient is at risk of such a problem.


One problem with this is that, I, as an individual suffering from anxiety, "regularly" suffer form chest pains.

This often spirals into the terrible cycle of anxiety -> chest pains -> anxiety about the chest pains being a heart attack.

I can only assume that the chest pains will be different and more severe if I should ever have a heart attack.

http://www.calmclinic.com/anxiety/symptoms/chest-pain


Literally yesterday I treated a patient who has had 4 presentations this year to emergency with chest pain that sounds cardiac enough, except it lasts for several hours sometimes and sometimes she can 'feel it coming on' and heD it off by relaxing. Still, it could always be a heart attack and until a through work up is done to exclude it (acutely, ECG and troponins, as outpatient, stress test), it is worth investigating.

In her case the deeper I delved into her personal life the more it became apparent that this was a clear cut case of stress/anxiety related pain- that was having physical manifestations.

for her, we discussed exactly what you are describing: that anxiety leads to the pain, which then leads to fear about it being a heart attack, which worsens it etc. we went through the work up we had planned and after her second troponin was negative we sent her home to have an outpatient stress test to see if she may have some partial blockages. If that is clear, we as medical personnel feel comfortable knowing that her episodes are non-cardiac in nature- and referral to psychologist for CBT (which she had previously undertaken to good effect) was recommended. I think she will do well, she appears willing to seek help.

I hope you are also seeking help for your anxiety, and that you have had at least one good work up for your chest pain to exclude a cardiac cause.


Amazon has some home ECG monitor device. Do you recommend their use?

I execise regularly. If those device are effective, I would love to use them weekly or monthly on myself and collect the data long term for me and possibly my doctor.


the technology is very simple and very old so without knowing what sort of machines they are (if they are like [1] then they are more for monitoring abberant rhythms than detecting infarcts or ischaemia - it doesn't have enough leads to properly detect a heart attack) they may do an ok job; the real question is of benefit. There is little benefit to be obtained from regular ECG in an otherwise healthy person. You can't/shouldn't perform a home exercise stress test as you need to be in a hospital environment so that you could be resuscitated if things go badly.

For data collection or your own interest, a proper 12 lead ECG is a great reference item; but again if the machine is like [1] you are only going to get this simple trace that doesn't tell you much; even serial ECG's on a normal healthy patient (or even someone with moderate heart disease) will be almost perfectly normal day to day, month to month at rest.

So I would be inclined to suggest that it is a bit of a waste of money from any attempt at home diagnostics, however if you were concerned about your cardiovascular risk you should discuss it with your doctor.

[1] http://www.amazon.com/Medical-Real-Handheld-Portable-Monitor...


Let's say if we can get (build) a proper 12 lead ECG with proper home/protable monitor.

Is there such thing already?

Collect all 12 leads signal via bluetooth connection to a Iphone/Mobile device.

Whenever I do a 30,60 minutes exercise in the GYM, the system will collect all the data and store them in my personal cloud.

Whenever I did annual checkout with my PCP, I will go over the data/chart with him/her and see if there are any abnormalities that might trigger any concerns.

If they spot any potential issue, than we have more info to do proper stress tests in the hospital and lab setting.

Would this kind of device/process be valuable from your ( Doctor's ) point of view?

BTW, I have background in embedded system, cloud backend, and some mobile app, if any doctors think these kind of monitoring devices are useful. I can definitively love partner up working on such project. My mom suffered from heart attack a few years back - so this topic trigger a personal nerve for me.


Reading and ECG is not as easy as it sounds. Without training no a chance in hell it will mean anything to you unless your flat lining and then you won't be reading anything.


I suffer from anxiety and panic and have for years. Just reading this post and your post makes me anxious. The reason being I have seen a Cardiologist and had stress tests but years ago. 2 of them about 9-10 years ago after so many ER visits and then another about 5-6 years ago. All were fine.

EKG's have always been normal as has blood work when I did go to the ER. At my primary care doctor EKG's have also always been normal.

I have been in CBT and getting better but I have to say your post kinda opened a wound. The reason being my primary care doctor says I don't need a stress test and that the prior ones are good enough. She says given my age of 29 and risk factors there's just no reason for it. So far she's been right. Over the last 12 years the hundreds of times I have had chest pain I am not dead yet.

I guess now you have me a tad worried. My primary care doctor and her colleagues have been so convinced at times when I show up with chest pain they don't even think a EKG is necessary.


Hi there. I'm sorry it caused you worry to read what I had written. I was speaking largely in general terms - as I am sure you would be aware discussing medical situations, despite being medically trained, over the internet is not the best way to do things and I would hesitate to tell anyone that it is ok to sit at home and do nothing if they experience chest pain they are concerned about, it should be investigated at least once throughly.

It certainly does sound that if you are known to a cardiologist. have previously had negative stress tests and have had recurrent episodes of the same type of pain with negative ECG's then you have been worked up appropriately to exclude a cardiac cause. Your primary care doctor knows you much better than I ever can over the internet so I defer to their more expert opinion and interpretation of your recurrent presentations. Take solace in the fact that previous investigations have shown the pain to be non-cardiac in origin.


Wow, that's horrible, but I'm also upset you put it on robbiep. It's random advice on an internet thread titled "Just had a heart attack" under a comment "Can someone with some medical experience write about what are exactly the warning signs for a heart attack?".

That sounds like there was more than ample warning about the subject matter. If it's triggering, you might not want to seek it out?


It could be a tense ribcage muscle. If you stretch and the pain changes then it's probably a muscle.


It is that at times. But sometimes not.


I suffered serious anxiety and panic for a couple of years. Called 911 several times, thinking it was a heart attack. My wife, who is a doctor, humored me through these episodes, though she knew what was going on. One day, as I came to her again and proclaimed I was having a heart attack, she said, "You know, if you're standing up, you're pink, and you're telling me you're having a heart attack, you're probably not (having one)." That calmed me down. Over the next year, I learned to "fix" my anxiety, and now only rarely feel a wave of panic coming on, and even then, can get it under control.


> The 'typical' signs of a heart attack are chest pain usually described as dull, heavy or tight, with radiation to the arm(s) and neck. The patient often also complains of diaphoresis (sweating) , shortness of breath and perhaps weakness.

This is mostly for men, right? I've read previously that the symptoms for women are quite different.


I'm glad you brought up the point about women, because I'm actually writing this from my mother's hospital room where she's been for about a month after a heart attack of her own.

Her experience was very, very different from what we're taught to expect from a heart attack as men. She'd been nauseous and tired, with some chest tightness and general malaise, for a period of about 4 days before my stepdad told her to go to urgent care, where they put her on an ambulance to the ER, where they admitted her to the cardiac ward. She had been having a heart attack for most of that four-day span and wrote her symptoms off as "just part of being a 66-year-old woman." The length of the event caused her to go into shock, and she's had all sorts of problems falling out from that. She's stable now, at least, and is recovering well, but she should've sought medical care much, much sooner.

Since this happened, I've spoken with dozens of men and women I know about heart attack symptoms, and so far only a couple of people knew how different the presentation was across genders. If you have any late(ish)-aged women in your life about whom you care, make sure they know what a heart attack might feel like for them. My mom got lucky and has had a great team of doctors working on her recovery, but you can't count on luck the way you can count on knowledge.


It's common for women to have pain in the center of their back (basically directly 'behind' their heart). Nausea is another reasonably common symptom for both men and women.

There's no guarantee you'll have any pain at all... Honestly, someone who is diaphoretic and nauseated is going to get an ECG, even if they don't have any complaint of chest pain.


As someone who had a heart attack exactly a month ago (100% block on LCx) I can say that I had pain that started in the arm, went up across my shoulder blades and pain in my jaw. Cold sweats as well. It happened over a period of about 15-20 minutes.

Luckily I recognized the signs and was very near a hospital ED. I wasn't in incredible pain, but I knew what was happening. I was actually driving and made the decision to get to the hospital instead of calling an ambulance, as the time would have been longer.

Got to ED, straight to a bed, then ECG and bloods taken, two hours later angiogram/plasty and now have a stent in the Circumflex artery and working on the other problems.

Fortunately it looks like the damage has been fairly minimal. Echo cardiogram shows mostly "normal", but getting a thallium test next week.

I'm T2 diabetic and had let my sugars get out of control.

Don't do that.

Now I'm doing the exercise and diet changes that I should have done a long time ago.


> I'm T2 diabetic and had let my sugars get out of control.

What were your readings at the time, if you don't mind?


THe only sure fire way to check your heart is to have them pump some fluid in that allows them to see your heart and arteries pumping real time on a screen. A catheter operation in the cath lab. This can be expensive though I have heard there is a good deal in CHicago for a few hundred dollars. The rest, i.e., ECG is not a guarantee of diagnosis, I had several before my infarction as routine check ups and none revealed a 90 percent clogged LAD (Widow maker) and similarly clogged RCA and 50 percent clogged circumflex (which they didn't stent yet because stent cut off line is %70). Perhaps a stress test with the ECG is better. But taking a live camera look is the way to go if you really want to know, you can go in in the morning and be out by the afternoon if all goes well.


This procedure is called Angiography and I had this done for my dad after he was suffering with lack of stamina and heavy breathing even with mild exertion. The doctors found 5 blockages which wasn't surprising since he used to be a smoker and a foodie. Multiple stents were put (couple of blockages were so bad that the couple of wires used to make way for the stent bent and couldn't penetrate but thankfully they were not in the bigger arteries).

I've resolved to undergo Angiography, symptoms or not, once I turn forty. Angiography is not cheap but it is way more cheaper considering the costs of stents (specifically the ones that dissolve are quite expensive). A day of preparation and an hour of discomfort is nothing at all considering the benefits.


I had no idea angiography could be an elective procedure with no symptoms present. Thanks for sharing, something to think about.


I agree, something to think about, but the very first hit on Google for "elective angiography" was an article discussing whether it is over-used due to the dangers including significant radiation. :/

Where are my darn nano-mites!?


I don't display heart attack symptoms well perhaps due to a high tolerance for pain. That said symptoms include some sort of pain, chest (elephant sitting on chest), jaw, in my case a feeling like a baseball pressing into the hollow of my left shoulder. When it started my very first thought was "I am having a heart attack." Which is to say when you have a heart attack its distinct enough from anything else you ever felt on your body you probably recognize it as a heart attack. So don't worry, you will know when you have a heart attack as long as you don't slide into immediate denial. Another sign of a heart attack pain is the pain gets worse and one squirms to try to get away from it (like a leg cramp setting in type squirm)so as it gets worse you will definitely ask to be taken to a hospital unless you are utterly insane. For me it wasn't what I connote as "pain" which has a sense of sharpness to it, it was more like a pressure in an area that was very uncomfortable.

By the way your heart doesn't feel pain itself no nerves for that, which is why there are all these other spots that get reported as uncomfortable or painful because the body "finds someplace else" to express the problem. The other sign is the shortness of breath and gasping...this must be simply because your body is responding to the heart not getting oxygen past the artery blockage (downstream)and is trying to get more oxygen. Note also when you get that second stent they are blocking an artery to insert it so you get a chance to experience the heart attack feeling as per shortness of breath if you missed it the first time.


That's how my dad died. Mom found him on the couch with a bottle of pepto bismol next to him.


I'm sorry for your loss. My dad thought his heart attack was indigestion too. Ended up with a quintuple bypass and is still with us but it was really close.


Amazing response. Answered question, provided additional caveats, and even background information! Thank you, this was of interest to me and very helpful.


"... almost all from a coronary artery called the left main blocking...These patients unfortunately almost all dead on arrival."

How can we monitor this effectively? There must be a solution that does something after something has registered a problem.


This isn't as straightforward as you might think... Checking for occlusion of coronary arteries is a reasonably involved process.

https://en.wikipedia.org/wiki/Coronary_catheterization


Can you speak to women having atypical presentations? I did some reading after my mother had a MI and it seems fairly common for women to have longer, sustained nausea and discomfort vs. the classic male symptoms.


Could a smart watch detect a heart attack?


To take an ECG tracing you need at least 3 points of contact with skin around the body (a hospital ECG has 9 leads attached to the body from which the machine calculates 12 waveforms of electrical activity). A watch based mechanism would not have the capacity to do this and even a 3 lead ECG would not be considered sufficient as it would miss too many changes.

I therefore believe that a smart watch would not with any current technology be capable of detecting a heart attack.. Pulse and heart rate are simply not useful (neither sensitive or specific) criteria for detecting MI's

For further reading on the physics of an ECG hit up

http://en.m.wikipedia.org/wiki/Einthoven's_triangle

Edit: my ECG knowledge is a bit rusty- 2 points of contact is enough to produce a single waveform reading...


> Edit: my ECG knowledge is a bit rusty- 2 points of contact is enough to produce a single waveform reading...

Any just to clarify further... you'd need two points of contact that complete an electrical circuit. You couldn't just wear another watch.

You _could_ wear two watches and have a small wire that you use to connect them together when you want to check, but that's only going to give you Lead I, which is one of the less useful leads (and it's completely useless in isolation).

If you really wanted to get crazy, a watch on your right wrist connected to an anklet on your left ankle would give you Lead II, which could at least get you a look at the inferior aspect of the heart (and therefore the RCA).

But I'm just getting silly now... If you think you're having a heart attack, call an ambulance. They'll do a full 12 (or 15) lead ECG right in your bedroom.


How, about detecting one of the side effects of a heart attack? You can then evaluate if you have a problem by any of the other symptoms. If I'm experiencing chest pain and my smart watches is indicating that my heart rate is irregular, for example, maybe I shouldn't be ignoring this.


A heart attack isn't likely to cause an irregular heartbeat (at least not until well after the damage has been done). It's common for heart attacks to cause cardiac conduction anomalies called 'blocks', but these generally don't result in any irregularity of the pulse.


Yeah, I'm simply throwing out a strawman. I have no idea what's possible or important.

http://en.m.wikipedia.org/wiki/Straw_man

The important idea is that I'm not asking the wearable to tell someone that they're having a heart attack but simply indicate some one "test" is not within range.


Unfortunately, there aren't any tests that could be run at the wrist that would be even remotely specific for an MI.

Really the only thing I can think of is some sort of transcutaneous monitoring of troponin levels in the blood, but that's hard to do (without needles) and a late indicator... troponin levels don't start rising for a few hours after the damage has started.


While I was waiting to go into the angiogram, I was feeling my pulse... it was weird, there was three beats, then a gap, or three regular beats and a fourth straight after the third... was fascinating to listen to...

Apparently I'm weird because I wanted to watch the angio. They kept telling me that they "didn't need my help" :)

I was saying "how often do you get to see your insides?"


Cool. That sounds like a pretty classic 2nd Degree Type 1 Atrioventricular Block (also know as a Wenckebach block).

If the area of infarct impacts a part of the heart responsible for electrical conduction, stuff like that can absolutely happen, but it's not especially common.


"Pulse and heart rate are simply not useful (neither sensitive or specific) criteria for detecting MI's"

I have a statistical medical question. Is the problem that they're completely unrelated, or that interpersonal variation is larger than the typical impact?

Very long term data analysis with a sudden change might be much different than the experience of a ER doc seeing someone for the first time.

I guess the relevant data source would be someone hooked up to monitoring gear in the hospital when they have a second heart attack while onsite... it might not even be visually obvious but perhaps a detailed statistical analysis would show something before/after.


It would be neat if someday this could be built into clothing. Maybe not for the mainstream, but for people who are at high risk. Just a thought.


If it can accurately monitor your heart beats, then I believe it should be able to identify patterns that signal an impending heart attack. I'm not a doctor tho, so don't take me too seriously.

Edit: Apparently I'm wrong, I know nothing about ECG.


Honestly I'd go ahead and just strikethrough your entire comment. This is terrible advice.


What can you say about rapid heartbeat increase but no shortness of breath after walking up stairs?


Here's the thing - people experiencing a heart attack can have any combination, or none of the symptoms. So here's some of the symptoms, bearing in mind that they may or may not apply to any given situation.

Chest Pain The first and most obvious sign is chest pain. It may be radiating down your left side (jaw/arm). It is generally described as a crushing pain. This symptom is less likely to occur for women or people with diabetes. If the chest pain is not relieved by resting (i.e. sitting down), it points towards a heart attack.

Shortness of Breath As a body attempts to bring more oxygen into the body faster (because your heart isnt perfusing efficiently anymore), breathing will become faster and more shallow.

Pulse - Rapid, Weak You should take your pulse a few times a year to get a baseline of what it's normally like. During a heart attack, it can become faster and weaker. However, this is relative - your pulse may normally be weak. This is why it is important to have a baseline.

Nausea, Dizzyness, Sweating, Weakness These physical symptoms by themselves are usually not a concern (they happen with many sorts of illness really) but in combination with the above can be a warning sign.

In any discussion about heart attacks, it's important for you to understand the risk factors: http://www.mayoclinic.org/diseases-conditions/heart-attack/b...

If you're high risk and are suffering from the above symptoms, its always advisable to err on the side of caution and call the emergency services. In fact, if you're at all worried, just call.

There are some things you can do to help yourself during a heart attack: 1) Call emergency services. 2) Make sure emergency services can access you, especially if you're on your own. Unlock door, etc. 3) Half sitting position. Place your back up against a wall and sit with your knees raised. 4) Take an aspirin. This will thin your blood and relieve pressure on your heart. 5) Try control your breathing. 6) Try not to worry (yeah, I know, this is a hard one).

Source: EMT (Emergency Medical Technician) with voluntary ambulance services.


If the chest pain is not relieved by resting (i.e. sitting down), it points towards a heart attack.

But if you have repeated episodes of chest pain relieved by resting, it might point to angina pectoris -- not technically a heart attack but potentially serious. If it's unpredictable pain and not relieved by rest, it could be unstable angina and much more serious. Yet another thing that makes heart trouble difficult to distinguish from anxiety.


Yes, that's true.


My case is a bit different. First I had tooth pain. I went to the dentist pointing him the tooth. He made a radio and said that I could not have pain because this tooth was abnormal and had no nerve. I didn't investigate further. Later I learned that hart pain can be linked to tooth pain.

I later had a huge pain in my elbow. It was as if a big nail was hammered through it. I then went to my cardiologist and he noticed a change in my ECG. I did a ECG under effort and he stopped it after a minute. My ECG became completely crazy under effort. I saw it later. From this point things went as routine work. Got a stent and everything is now ok.

So symptoms my differ. I never had chest pain. Only elbow pain. The tooth pain was also a hint I now monitor. When it hurts I know I have to be careful with what I eat. It then calms down.


http://www.heartattackfacts.org.au/warning-signs/

Strangely enough I'd just seen the poster that had all this on it the week before my attack when I was at the GP for a general checkup after a cold.


It's kind of ironic that these are the same symptoms as stress related panic attacks.


Thanks for your response. I was always curious about something. My father inlaw was admitted a few years ago for bypass surgery. Upon inspection, they found (I'm doing this from memory so apologies if I get some of the numbers wrong) that 4 of his arteries were partially blocked, some up to 85%. In fact, his body produced a natural bypass on it's own because one artery was so clogged up (it literally created new connections to bypass the clog albeit much smaller then the original)!

My question is why can't we detect this high level of blockage much earlier (as in with a physical). Are the tests too intrusive or too expensive to recommend that the test(s) be performed periodically (eg maybe every 5 years after 30 or 40?)

Thanks!


Blockages of up to 90%, whilst considered 'critical', typically cause little in the way of symptoms.

The gold standard for detecting vessel blockage is angiogram- puncture the femoral or radial artery, feed a catheter to the top of the aorta and squirt some dye and then watch it on X-ray. This has risks however- risks of rupturing artery walls, causing bleeding and bruising, and can be expensive. So it is not routinely done: in fact it is only indicated if a patient presents with a MI (gold standard is to have the patient in angio lab within 90 minutes of onset of symptoms, which is great because if they are they can generally reverse the blockages with stenting before long term damage occurs), or if a patient has a positive stress test.

CT angiograms are becoming more common but still not commonly used due to decreased sensitivity.

If a patient is believed to have risk factors for artery disease then they may be given a exercise stress test- hook up to an ECG, get on a treadmill and if there are changes consistent with vessel ISCHAEMIA (as opposed to infarct), then an angiogram will usually be scheduled.

For patients too unwell for a exercise stress test nuclear medicine stress tests can be performed.

And finally in patients who have blockages in more than 3 arteries, the gold standard is still (for the time being) coronary artery bypass grafting.

I guess to summarise, the reason we can't detect it earlier is because generally we require invasive means to do so and invasive tests carry risk to the patient that are hard to justify for screening purposes. Perhaps in the future CT angio may be made more readily available, the scanners keep getting better and better and resolution increases all the time however you always want to minimise a persons radiation dose as for every 3-400 people scanned you can cause one instance of cancer... Something you must always be mindful of particularly in children


I didn't quite get the 90 minutes, got symptoms starting around 15:30, was in ED at 16:30 and getting the angio at 19:00.

The interesting thing (aside from watching the angio, the technology is very cool), was that I'd previously had a minor infarct and didn't know it on a much smaller artery.

They found collaterals (I think the terminology is right) where the body "bypasses" the blocked artery.


that is the right term - it happens when there are long term arterial subacute blockages - ischaemia/reduced oxygen flow triggers tissues to release vessel growth factors that will lead to extra artery growth.

Bizzarely this leads to situations where diabetics (who develop lesions all along their vessels, and thus have lots of areas of narrowing) can potentially be more protected from a sudden blockage compared to someone with an area of only one blockage - they have enough collateral circulation that the area of infarct is smaller with less damage resulting


Yay, something that diabetes actually benefits :)

No, not really, but hey, its worth clutching at straws...


I have the same question. I knew someone in their early 40s who had a heart attack recently. He seemed healthy otherwise - well ... he is borderline overweight compared to me. Why don't we have better diagnostics for this?


This is a great question- I believe from family history that I'm at risk for this.


I don't have medical experience, but I had a heart attack a year ago. This is what I felt:

- Feeling diffusely sick, no specific pain, but a feeling that something was wrong.

- Oppression in the chest.

- Mild pain in the left arm

- Cold sweat.

I tried to drink some water, open a window to have fresh air, sit and relax, but after a couple of minutes nothing improved. I was at the office (alone) so I googled the symptoms of a heart attack and next thing I was calling 112 (Spain's equivalent to 911).

It was a mild heart attack, I got a procedure in the ambulance that stopped the attack, and a barely had heart damage. I had a triple bypass surgery a week after the attack, because the three main arteries were clogged. So it went well, because with those arteries I could have had a more serious attack at any moment.

My advice would be, if you are not feeling right and you never before had those symptoms, call 911 (or whatever the number is in your country). The people that picks up the phone are trained to assess the calls, and anyway it's better to raise a false alarm than to die.


I found this, but these symptoms seem so general that I feel like I must have had dozens of heart attacks! http://www.nhlbi.nih.gov/health/health-topics/topics/heartat...


For me this is a real issue. I have genetic high cholestrol (I'm on 80 mg lipitor) and I suffer from gastric reflux and excessive gas. I've been to ER twice when I thought I was having a heart attack but it was just bad gas/heartburn :( Now I'm sure to dismiss the real attack...


Are you overweight? Does your gastric reflux / gas have any associated episodic shortness of breath? Just trying to make parallels with myself.


No I'm not overweight would be suicide for me ;/. No smoking or anything like that. I am a bit unfit though.

I've never had shortness of breath while not active. That's also what the doctor told me to look out for. It's still scary and confusing though.


Just thought I'd chime in with the fact that I have had quite a few heart attacks and nobody's mentioned one of the overriding sensations I repeatedly had, and that was one of having a belt tightened around my chest. Like there was literally somebody stood behind me tightening the thing, and the longer it went on the more it felt like an iron band was clamping tighter and tighter. Not fun.

That's also one of the terrible things about anxiety bringing on these types of symptoms, if you've already had a heart attack and subsequently you have an anxiety attack which brings on similar symptoms there is just no way to discount anything (for me). Also not fun.

Luckily the heart attacks I had weren't the result of an underlying problem with my heart, it was because I was going in to urine retention which caused either sodium or potassium to build up in my system causing all the problems. I can never remember which one it was!

But seriously, if you feel the symptoms get help.


Last year when i was 27 i had a strange feeling in my chest after smoking a cigarette, i didn't smoke for 4 years in row. After 2 minutes i got very nervous and i felt overall very strange.

Two days later i smoked another cigarette and the same feeling started again, but this time it felt like ants are running up my neck. After 5 minutes and calming down me teeth started to itch. From day to day i got more and more weaker. After 4 days i couldn't walk more then 25 meters without pain in my chest and short breathing. Thankfully one of my co-workers dad is a doctor and he said that he wants to take a look on me. After i arrived at his office i had to walk up 20 stairs and when i opened the door i've fall down on the floor.

Immediately two people took me to a room where they checked some stuff. My doctor made some tests and he said that it doesn't look like a heart attack but something is wrong with one of the lines on my ECG. He asked me if its ok to call the ambulance for doing more checks at the hospital. I said yes, please.

5 minutes later ambulance arrived and took me to the hospital. I was quite unsure if i should be happy or not as my doctor said it doesn't look like a heart attack. In the emergency room they took my blood to check if troponin is in my blood. The test was negative. I told them my history and the history of my dad who had his first heart attack with 36. I had 92 kg at 172cm. They made some other checks and everything said my heart seems to be normal, except one line on the ECK. The doctor said i have to stay for at least 1-2 days for additional tests.

First night, they check my blood pressure shortly before i slept. 180 / 130 @ 80 bpm. They gave me some stuff to get it down to a normal value. First morning, i woke up. I had pain in my chest so hard the i was close to fall out of the bed. Rolled left, rolled right. 2 minutes and 20 clicks on the emergency button later a nurse came into my room and gave me painkillers. 10 minutes later ECK + blood test. Everything negative except that one little line in the ECK. Two hours later i they made the first test. They brought me to the ultra sonic room were they took a look on my heart. 10 Minutes later they said, everything looks normal. One day later the next test. Cycling. I had to stop after 2 minutes and a pulse rate of 120bpm. The nurse asked me if i am serious that i cant ride more. They expected me to get up to 180bpm. The doctors got nervous, my blood tests are still negative, no troponin and the ECK is also negative, except one line. They decided to make a test called echocardiography. While watching my heart the gave me a medicament to speedup my heartbeat. When they hit 120bpm i started to sweat, at 130bpm they gave my emergency medicaments to calm me down. It took almost 30 minutes and 1 lorazepam to calm me down.

After that test they put me to the intensive care unit. For the first time they found troponin in my blood. I had 10+ cables all over my body. Every 4-5 hours they made blood tests, also when i slept. They gave me blood thinner and tranquilliser. After 4 days in intensive care unit they made a cardiac catheterization and they found a 99% closed vessel after 10 minutes. Another 10 minutes later i had my first stent. The complete process took around 45 minutes always with full consciousness. I felt horrible but i was so lucky that they found the problem. One day later the doctor told me what happened and what the future is. They said i can live a normal life without the risk of a heart attack but i have to change my life radically. So i did. One year later i am doing sports multiple times per week. I lost over 15kgs, never touched a cigarette again and i feel so much healthier now.

My doctor told me after everything was over that 3-4 weeks later i would be dead without help. My heart has no damage and only 2 little 30% spots are left. As long as i live a normal life and i don't want to run marathon i wont have problems in the future. The little strange ECK line is also normal now =)

I hope that my english didn't distract you at all, i want to show that even not normal signals of a heart attack can be a sign of much bigger problems coming up.


For the first time they found troponin in my blood

Probably a selfish, personal comment, but I immediately searched for the word "troponin" in this thread and smiled to see it in the second post.

As an engineer having spent the last decade or so on an instrument that, among other analytes, measures the level of troponin in your blood (serum), it's quite satisfying to remember that my work is saving lives. Sure, you may not have been analyzed by one of our instruments, but somewhere a group of software, electrical, mechanical and biomedical engineers out there suffered through the miasma of FDA-required procedures, onerous development process, reviewing every line of code, arguments about exactly what a STAT reponse means, ridiculous training requirements, long validation procedures run by the most anal testers ever and ended up with an instrument that helped save your life.

It might not be as exciting as state of the art webapps, but it's nice to be reminded that we matter.


Well yeah, it might not be as exciting as webapps, but that's the difference between a job and a hobby. If your daily job includes exactly the kind of craftsmanship you could spend years doing happily, that's great; but if your job is more boring than that, you still have a few hours each day to devote to the more exciting kind of software development. However, in the meantime, your job, as boring as it might be on the worst days, is still saving lives and working for the good of the society. Hell, I wish I could say the same about my job (which may affect millions of people around the world, but in a far less relevant way).

Yes, you do matter. People are better off thanks to you. Sincerely: congratulations, you're a lucky man.


It is far more exciting than webapps.

Webapps are the technical equivalent of Richie Cunningham but biomedical engineering is The Fonz.


>I hope that my english didn't distract you at all, i want to show that even not normal signals of a heart attack can be a sign of much bigger problems coming up.

It is my experience that those who self-apologize for their "poor" English skills are the ones who have the least to apologize for. You have a better grasp of the English language than most college graduates in the United States.


I'm not sure if this is a Dunning-Kruger effect or not, but it sure feels like it.


Thank you for this comment. For about a year and a half I've had problems with shallow breathing that have gotten worse and now just become normal (I always feel like I need to get a full breath, and can never do it because I breathe too shallowly when trying.) I have been having chest pains frequently. I went to see a doctor and without even listening to my chest said it was anxiety and to go see a psychiatrist.

That was a couple months ago. I think I'm going to go somewhere again. Maybe a psychiatrist, maybe a different doctor.

I'm the kind of person who just sits on things without really caring, and I probably do need to get this checked out.


I had a similar experience. Not to discourage or demoralise you, but keep a close check on your cardiovascular system. I had 3 relapses (stenosis) since my first stents in October 2010. Did (and continue to do so) all the right things, have all the right measurements, blood and fat values. Yet every year in January/February I'm taken back to cardio-surgery for yet another stent because of yet another stenosis. Hope you fare better.


Thank you so sharing, it's a good reminder that careful focus on health can't take a backseat forever. It's great to hear how much better you're doing now.


Good luck, and congrats on making it through the woods. Sounds like you are in good hands which makes all the difference.

You are right on the money about calling 911. As men we tend to be slow making the call, and don't want to seem like whiners. I always think of the line from The Edge - "Most people in the wilderness, they die of shame".

Had emergency surgery for aortic dissection myself in february (mentioned it on caffeine thread here: https://news.ycombinator.com/item?id=8520241). I felt for a moment like someone grabbed my heart, then agonizing back pain took over, and some nausea. But no more chest pain. I really just assumed I hurt my back working out, because I do easily it once a season (though I'm getting older, but am acting younger)

I sort of ruled out heart issues because I did cpr in real life a few days earlier (I'm a fireman with FDNY (though now probably looking at forced retirement)). And took my CFR (EMS-lite) refresher a week before that. Thought it would be a total coincidence it's my heart.

Even though it takes time to heal, 8 months later I have mostly "healed from the healing process", and you will get there in time. In some weird way it is one of the best things to have happened to me too, kind of plants your feet on the ground in the way few things can.

The major post surgery things I had were:

- Chills waking me up at night

- Nerve damage from my shoulder being mis-positioned at some point

- The pericardium being partially removed during surgery lets me hear my heart much more intimately than I'd like to

But all these are way better now. Still have a lot of insomnia still.


Congratulation on your recovering. If you don't mind me asking, why is a fireman interested in HN?


I'm a software developer too. Was before I joined the FDNY (in 2003) and still am.

Most firemen have a 2nd job, mine just is a little more cerebral than most (though there are doctors and lawyers on the job too).

Always loved having this split brain. The split aorta, not as much :).


I had my MI when I was 23 when I was cycling to work. Took me about two hours to get treatment, and I was lucky as my Triponin peaked around 35 IIRC. My symptoms were chest pains (not too severe, about as bad as a really severe running stitch) and an extreme shortness of breath.

I didn't find Rehab that bad, but then I was the youngest person there by about 30 years and a bit of a novelty. The drugs were the absolute pits though, I found that my reaction time dropped by about half a second. It took me about 2 months to be able to play squash again even after I regained by physical fitness.

They never found a root cause for my MI (there was no plaque , and they don't know why the clot formed). I still get asked if they know why it happened - like that's the most important thing. It's okay to not want to share any causes of your MI with everyone who asks. Apart from your medical professionals, they don't have a right to know.

Good luck and let me know if you ever need to talk.


The main risk after starting to have a heart attack (other than dying)and clearly realizing it, seems to be going into denial and not proceeding immediately to a hospital. That circus lasted almost two hours for me, so by the time the stent cleared the clot I was just on the edge of being on the way out (becoming unconscious). - I even had a smoke in the middle of the two hours before heading to the emergency room!

Next phase was the month to a year as one ponders whether one managed to induce heart failure (enough damage not to pump blood in sufficient quantities) when faced with the tiredness any exertion including rehab seems to induce. The possibility of always being tired IS DEPRESSING. Also there is the "fun" of pains in the area one felt the heart attack pain bringing the question of "am I having another heart attack." And then there are all those stories about how great someone or other felt after having their arteries cleared as if one got a tune up...these stories are B.S. one is looking at about 6 months of not feeling great with any somewhat serious heart attack.

My overwhelming sentiment as the anesthetic set in before they cleared my Widow Maker and inserted a stent was, well, feeling pretty good and the notion there were "worse ways to die," and a certain willingness to go with it if this was it. So I guess I'm not much scared of dying once there.

Mentioning the heart attack is devilish fun in a gathering because most males start to squirm immediately.

There is a disconnect between one feeling fairly back to oneself and other's views of you who has had a heart attack(if they never had one). No one will learn from your example and stop smoking or eating less crap so don't even bother to think so. You'll be lucky if you manage to improve yourself your own bad habits.

After a while one resumes ones devil may care posture towards life with occasional reflective moments on when the 'next one' will be and if there will be a next one(probably).

So as far as great revelations? Not many mostly mundane discoveries. A stent is better than being filleted. Being alive appears better than dead to those of us that are still alive. And next time I feel a heart attack I WILL GET MY ASS TO AN EMERGENCY ROOM ASAP to reduce heart muscle damage that ensues the longer I wait.


I am a 48-year-old T2 diabetic - I'm not grossly overweight and there is no family history of the disease; it is suspected I became T2 following a viral illness coupled with a highly stressful job.

I ended up in Accident and Emergency (UK) after developing what was thought to be a bad chest infection - I was coughing up bloody fluid from my lungs. After a some examination and an ECG, I was whisked into a ward and scheduled for a angiogram. A day or so later, right after the angiogram, I was told I had some damaged blood vessels around my heart and I had "probably" had "at least one" heart attack sometime in the past!

Every physician that did the rounds while I waited for a stent operation asked me whether I'd had any further chest or arm pains and I had to keep telling them that I'd never had any such pains - no 'classic' symptoms.

The upshot was that the heart damage was put down to a combination of diabetic-related complications, possibly not helped by one of the meds I had been taking.

3 years and 5 stents later (should have been 4, but one of the blood vessels tore during the procedure so I had to have an extra 'covered stent'!) and I am still up and about - albeit with some reduced heart function.

So, as robbiep commented - "'Typical' signs do not present in everyone: in particular diabetics are at increased risk of having 'silent' heart attacks"


I'll also bring to people's attention an uncommon heart condition that won't nrcessarily kill you, but may change your life: pericarditis. I've seen it in myself and too many acquaintances lately - most people have never heard of it.

Basically this is inflammation of the lining of your heart. the most common cause being idiopathic (ie. We don't know), or viral, followed by trama post-surgery or radiation therapy. Sometimes it has been caused by vaccination (influenza and others).

The symptoms make this tricky to diagnose, but if you have some combination of fever, consistent or spamming chest and/or upper back pain, difficulty lying down or adjusting position, lethargy, shortness of breath, change in unrine habits / color, go get checked out - an echocardiogram will often reveal the inflammation. High dose (500-625mg) aspirin helps. Most times it will resolve through such NSAIDs or with steroids.

Left too long this can lead to liver damage and can become a chronic constructive condition that mimics heart failure. This is generally curable by surgery to remove your pericardium.


Can we expect a health-based startup being added to Fogbeam Labs after this?

In all seriousness, I hope you have a speedy recovery. Be thankful it happened in the RDU area. We have two of the best med schools in the country within a 30 minute drive of each other. I'm certain you'll pull out of this without a problem.


Heh, good point. We'll see what happens.


Get well soon. One of the biggest causes of death, especially for males is being too stubborn or too scared to get things checked out. Me included. Have a speedy recovery!


Stubbornness :) https://i.imgur.com/gXdTZ1z.jpg


Haha very, very appropriate!


This. I was so reluctant to call 911 at first, but i've been a firefighter and 911 dispatcher, so knew how important it was!


First, congrats. But this is strange, another firefighter? I remember fifteen years ago in a programmers gathering that we found out every one of us played a musical instrument. But this is a little stranger, it seems ludicast and you both worked in the same and had heart problems too.


I think people are scared it will turn out to be nothing and they'll be embarrassed or something. But the fact is, no one knows that it's nothing, until a medical professional checks it really is nothing. There's no shame in that.


I suspect that "worry about wasting other people's valuable time" is also part of it.


Had a friend at a shared office building a few years ago start feeling ill and sweating profusely.

I kept insisting he get medical attention and he kept saying he was fine, in the end I said either you go get medical attention or I phone an ambulance.

So he goes to a local NHS walk-in center (I'm in the UK) where the first nurse who saw him phone an ambulance, daft macho sod was having a heart attack.

Saw him not long since, he'd gotten back into cycling, looked incredibly well and had dropped 3-4 stone (42-56lbs) having just completed a 300 mile charity ride.

Moral of the story, if you start getting chest pains radiating into your arms, sweating profusely get your ass to the hospital ASAP or phone an ambulance, early intervention greatly improves the outcome.


Ever since I started my startup nearly 3 years ago I've been experiencing what I'd describe as heart "flutters", "sneezes" or "thumps"; very short and sudden "misplaced" beats. They happen very ocassionally, perhaps once or twice a week. I've done all sorts of checks with a cardiologist, but everything checked out fine.

I've since learned not to panic when they happen and just live with the little shocks, but, you know, I'm only in my 20s, I can't help but wonder what my heart will do when I get to my 40s.


At 40, I generally felt fine, but something in my heart rhythm just seemed out of sync. TL;DR - went to a cardiologist, who basically asked me "why are you still alive?" and wanted to install a pacemaker the next morning ("don't die in the meantime").


Well, what happened then?


Well, I didn't die.

Needed a valve replaced too (no point installing pacemaker, then replacing the valve and having to re-install the pacemaker), so "don't die" stretched out to 11 days. After getting to watch a live X-ray of my heart, had open-heart surgery (which my boss wanted me to take as a vacation day), had an external pacemaker attached for 3 days (whatever happens, don't pull those wires out...hey, stop turning that "pulse rate" dial!!!), and then had the pacemaker installed. So now I'm a cyborg, with periodic data dumps and parameter tweaking, and looking at a the-hard-way battery change (whole unit upgrade while they're at it) next year. I couldn't sleep on my left side for two years because a wire was inductively stimulating my diaphragm when pressed close; eventually reprogrammed the wire's voltage/current to a tolerable state.

Feeling great, appreciate software which doesn't crash, and mechanical valve ticks like a clock.

As a bonus, the software monitors other things (while it's in there, may as well), and served to mitigate atrial flutter when that (unrelated problem) tried to shoot my heart rate to >350 beats per minute, pacer slamming on the brakes at 150bpm. ER crew was surprised when I walked in and calmly explained the problem. Glad that was in place to keep things together until the drive-thru heart surgery (run a blowtorch up an artery, zap 2 distorted nerves, go home) to fix that problem.


That's hardcore, glad you are fine! I cannot complain about much now.


I complain about very little now. Having already been dead ("M'am, everything is going fine, they're stopping his heart now"), I know how bad it can get, survived that, and know nothing can be worse.


Palpitations are often stress related. I used to have sporadic one when I was really stressed out, but they end up totally disappearing. You probably know but as an actionable first step you could try to reduce your coffee consumption and see if you are getting better after a week.(assuming you are drinking coffee)

http://www.health.harvard.edu/fhg/updates/Surprise-of-palpit...

Taking some magnesium supplement could also reduce the symptoms, since a low magnesium level, caused by stress, can also lead to arrhythmia. Typically every time I am low on magnesium I experience eye twitches that are quickly disappearing after a few week of magnesium supplements. I am surprised it was not prescribed by your GP or cardiologist.

I don't really want to give medical advice carelessly but since you have seen a cardiologist the most serious cause have probably been taken into consideration.


I'm 42 and have had palpitations since I was in my teens. My father who is 72 has the same things.

My recommendation is to get checked out by your doctor and a cardiologist and trust what they say. Meaning, when they tell you everything is fine you should believe that.

I mainly experience PVCs (http://www.mayoclinic.org/diseases-conditions/premature-vent...). I probably experience those at least a handful of times per day. When I'm super stressed I can have them a dozen times per hour. The link I provided gives you common triggers and can help you reduce their frequency.


I am not a doctor (I don't even play one on TV). But a friend of mine had a similar experience (he also described it as feeling like his blood pressure was dropping, in addition to feeling heart flutters). After a number of tests, turned out he was having micro-seizures. He was prescribed an antiseizure medication and the symptoms stopped.

The cardiologist didn't find it. He went to a neurologist, and that's who diagnosed him.

Your situation could be completely different, but I thought I'd share the experience just in case.


Chiming in with another data point here.

Have had the exact same thing on and off for the last 10 years or so (I'm 33 now). For the longest time, it would just be one flutter every few months or so, but recently it's gotten as high as a few times a day. Definitely seems to correlate with increased stress/sodium/caffeine.


I'm experiencing the same thing right now, and talking to multiple doctors about it. They all claim it's related to stress, and multiple tests have found nothing at all unusual. I'm inclined to believe them, but it's damn unnerving when it happens.


Are there any symptoms that indicate that it's probably not a heart attack? I recently had "stabby" pains in my chest area and as I didn't know what it was went to urgently get checked out and it was basically muscle pain (chest wall pain they said, I think?) and said that intermittent very brief "stabby" pain in your chest wasn't the most usual symptom (But that getting it checked out was still a very good idea).

Is that correct?


One of the most common presentations for heart attack that turns out to not be heart attack is reflux. If it happens after a meal, and especially if it is relieved by antacid, it is unlikely to be a heart attack.

But then again, it could very well be. Which is why you will never find a doctor who will say 'it's ok' from the history alone. They need a workup anyway... If there are no ECG or biochemical markers of heart attack and it responds to antacid in the emergency department then we can prescribe its use ongoing.

The other one that every medical student gets that convinced them that they are having a heart attack is muscular or rib pain, like which you describe. People present to hospital with it all the time but we usually quickly exclude it as a heart attack.

If you're concerned, always present.


I had a scare about two weeks ago. I woke up in the middle of the night with a lot of tightness in my chest, which I've never really felt before. I was also a bit dizzy/disoriented and became extremely anxious over whether or not I was having a heart attack. My first reaction was to look online for heart attack symptoms and began reading how you shouldn't be looking online and should be going to a hospital.

The final straw for me to NOT act was that I had no radiating pain. No pain in face, jaw, arms, etc. I took an aspirin and went back to bed. The next day, I went to the doctor and the EKG looked fine.

The whole thing was stress-related. Two newborn twins in the NICU may do that to you. What was interesting to me was that these symptoms showed up several days after their birth and after any initial scares were over. By the time I had these stress pains, the babies were eating from bottles, gaining weight and were functioning as they should in room air.

The scary part to me was realizing that heart attacks aren't like they are on TV or the movies, where the pain is so intense that the person collapses. I'm very thankful that I didn't have a heart attack, but I learned a lot more about them from that stress spell.


Glad you're okay and thank you for the warning.

Could you provide any information as to what could be the possible cause of your heart attack? Your age, habits etc?


It's hard to say for sure. I am a touch overweight and haven't been very physically active of late. Combine with age (41) and my stress levels, and I expect that explains a lot of it. Genetics may factor in as well.


Looking at the picture on his LinkedIn profile https://www.linkedin.com/in/philliprhodes it does look like he may have been overweight. I suspect that is a huge contributing factor in this. I'm sorry if anyone get offended by this, but it does look like mindcrime could have been more proactive in looking after his weight. Now it's completely possible that mindcrime has some other condition which limits, or at least restrict his ability to do exercise, which makes trying to stay healthy a whole lot harder. But I would have thought for a lot of people it is caused by either: heavy smoking, heavy drinking, little exercise and a bad diet. Either way, I wish mindcrime a speedy recovery and hope he can return to good health as soon as possible.


When I was 18 years old and worked at a computer consulting company, my 41 year old boss had a heart attack. He was less overweight than the OP, smoked and got no physical exercise.

After his heart attack he went in for an angioplasty with one of those nicotine patches on his arm. Since having a heart attack, he was trying to stop smoking. His doctor looked him in the eye and said, "Well here we are. Do you want to live or do you want to die?" My boss said he wanted to live. So the doctor ripped the patch off his arm and said, "Just stop with the nicotine then."

OP you have a similar choice before you. I'm now 42 and I see your LinkedIn picture and "a touch overweight" is not what comes to mind. If your BMI is not into the obese category, I'd wager you're close to it.


One of the reasons I created my website http://meetandplay.com/ as after high school I stopped being active, gained 60 pounds programming and playing video games. As an adult you have to be really proactive to find sports to play they don't just fall in your lap anymore. meetup.com is also a good resource for healthy people doing healthy stuff like hiking, biking, climbing which I've used as well. My site is more for pick up games and locations to play. :)


Hate to be that guy, but Phillip you really have to sort this out. Take this as a wake up call. You only live once.


Yes, I could have been more proactive. I made a lot of sacrifices in terms of not working out, overwork, stress, etc., in the quest to get this startup going.


Maybe you can find some casual running groups in and around North Carolina? I attend one and we run every Wednesday and Saturday. Even though I'm 20 years younger than the average runner some of the guys (who were on track to be the position you find yourself in now) have really turned their life around with respect to looking after themselves. I would encourage anyone of any age or fitness to do the same. Having people around you who can encourage you makes it so much harder to give up.


Also, 2 hours a week is nothing in the grand scheme of things. If you have to commute, try commuting by bicycle or if you go by train, get off at an earlier station. I'm not sure what your commute is like in the USA (I suspect most people drive to work), but a lot of people in Europe get trains and buses - which does make that latter idea a bit easier.


Regular exercise makes such a huge difference in ability to handle stressful situations as well as dealing with long term stress. It also improves cognitive function measurably.

I don't know what else you have going on in your life, but you are sacrificing the wrong thing. Forty-five minutes a day is nothing for the benefits you get.


  > Learn the warning signs and call 911 if in doubt.
I'd be super-dead if not for this advice. Few years ago I was 34 years old. Only moderately overweight, and I was very healthy in general.

One night I had pain and tightness in my chest. This isn't really anything new, because I have asthma and sometimes it feels like that. But then I noticed pain radiating from my chest down the inside of my arm. I realized that was one of the signs of a heart attack.

Got to the hospital just in time. Almost went into cardiac arrest in the ER. Lips were blue, heart rate began to plummet, etc.

It turns out it wasn't a heart attack, actually - it was peridcarditis, an inflammation of the lining around the heart. In severe cases (although this seems rare) it can swell so much that your heart can't pump effectively. You can die. I almost did.

Moral of the story doesn't change! Even if you're young and healthy, get to a hospital if you feel something in your chest.


I usually don't pay attention to who's who on HN but last week there was an interesting debate on the status of semantic web, and the name "mindcrime" stuck as I appreciated his comments a lot. Always a bit of a shock to find out those virtual personas are made of flesh...

Hope you recover fast, and yeah EXERCISE (if the doctor says so).


HEY! So sorry to hear about that - I'm glad you're on the mend. Thanks for the warning/heads up to the community here, and I hope we're able to catch up when you're better.

Related to the topic... I've had 'chest pains' of varying degrees for... 20+ years - chest pains alone aren't going to signal me to call, unless I feel they're different somehow from what I've had in the past. Someone else posted below that arm pains and sweating usually accompany this, so I'll have to look out for those - never had those, but have 'chest pain' often. And yes, have been to ER and had scans, and they can never find anything. :/

GET WELL.


The deep insight is nearly dying doesn't necessarily lead to deep insights and perhaps one really has to 'die' and come back to get deep insights and maybe even that doesn't result in deep insights. The other deep insight is, "I didn't die this time and that's ok with me." Deep insight may seem mundane because its just living through proving the obvious things you already knew...might be a third insight. For me dying quickly anesthetized looked a lot better than dying slowly from cancer or in a car crash burning to death or a litany of other possibilities which I assumed was the case before but now I really believe.


One time I came back from a ski week with friends, I was feeling weak and had pain in my chest on the left. I fall gently on the floor and said to my friends I had pain on my heart, they panicked a little and quickly called the emergencies, I described my symptoms to the operator and they promptly told me it only was intercostal pain, that I should eat and rest for the day. The pain sometimes come back when I lift or run an move my arms, it is slythly annoying, I just hope it won't dull me from a real sign.


Also, don't hesitate to push the medical staff a little. Two family members were told they had no sign of heart attack and spent the following night having multiple infarctus.


Maybe I should go back and get my heart checked. Last year I found out I had a silent heart attack at one point(had to do some physical for insurance first time I've went to the doctor in about 8+ years). I was 27 at the time. I do remember one time in college having sharp pain in my left arm and all the signs of a heart attack, at the time I was doing some PT for a class and the instructor thought I was playing around trying to get out of it.

Good luck on your recovery.


I had mine in 2006 at 32. Details http://davidcrow.ca/article/1130/barcamper

Make sure you go your an annual check up. Figure out how to get some exercise. And pay attention to the warning signs.

Worst part for me was the 8 hours waiting for troponin levels. Well and the angiogram/pasty/stent.


Just wanted to say thanks for this post. I read it this morning, and after lunch had the worst allergic reaction I have ever had. Luckily I already had epipens, just in case.

I had never used one, but when it came time for it, I just did it. It probably saved my life. My airway was closing up. I dialed 911 and injected while the phone was ringing. All is okay now.

Anyway, thanks for the PSA.


Mindcrime, we're all here hoping for your fast recovery. The place wouldn't be the same without you. :-)


Once you realised you were having a heart attack, what did you think about?


Putting on clean socks and underwear for one. Feeling fortunate that CHFD has a station a block from my apartment.

Thinking that I should have called my mom more often.

Not much fear, to be honest. I have a pretty stoic outlook by nature, and I was almost killed a few times as a firefighter. And as an atheist with no belief in any afterlife, I don't fear death too much.


I wish you a speedy recovery @mindcrime. My good thoughts are with you..


Glad you are ok. I've heard this advice before and always wondered what degree of pain qualified. If you are up to it, would you mind describing the chest pains you were having?


It was a dull ache that slow spread through my whole chest. Also, my teeth stare to hurt, and I got chills / cold sweat. That was enough for me to pull the trigger on calling 911.


Regarding taking aspirin when you get chest pains, I believe the current advice is to chew an aspirin (300mg) as it is more quickly absorbed via the lining of the mouth.


Glad to hear you survived and are getting better.

When people say "start feeling chest pains" do you mean like WOW that really hurts, or hmm that doesn't feel right kind of pain.


Only speaking for myself (other people have different symptoms), thre was some chest pain in my upper left chest, but it was mostly in my arm and shoulder blades and jaw.

It wasn't like on TV... guy clutching his arm and thrashing around... it was more like "damn, that hurts! Why does my arm hurt? Hmm, now my jaw... why am I in a sweat... goddamn, I better get to the ER..."

I was actually pretty calm. Drove there, parked carefully, walked up to the ER... as soon as I said "pain in my chest, left arm, jaw..." all the bureaucracy stopped and the medical stuff happened. Took about 5 minutes to be shaved for electrodes, aspirin given, ECG and bloods taken.

30 minutes later was admitted and was talking to the cardiologist about risk factors of angiograms...


I would immediately call if the pain would last for over 1-2 minutes, even if its a light pain.


Can the AliveCor product detect a heart attack? http://www.alivecor.com/home


Glad you're OK!


1. http://www.everydayhealth.com/hypertension/treating/medicati...

2. Drink warm water with lime to stay healthy http://m.timesofindia.com/life-style/health-fitness/health/D...


Oh my goodness…glad to hear you're okay.


Not sure why but the title made me laugh.


It is just so casually putted that the level of seriousness associated with a heart attack makes it absurdly to be putted this way. Where I am from, in Romania, a heart attack is basically a death sentence. Regarding this, I have read an article recently[1] which stated that in Romania only 3% percent survive if they have a heart attack outside of a hospital.

[1] http://www.romanialibera.ro/societate/sanatate/doar-3--din-c...


No worries. I couldn't really think of any other way to put it


Actually I thought this is going to be one of these cases where people update their Twitter status before calling for help[1]. I'm glad it wasn't.

1. http://scitech.blogs.cnn.com/2009/09/08/trapped-girls-update...


Glad that you're OK.


Thanks, me too.


No 911 service here in Kenya :-(


What do people do in case of an emergency? There must be some local version of 911, no?


Hopefully friend or family have a car and are able to get you to some sort of medical care. If not, you die (I've spent some time in Kenya, and as a paramedic, I was curious about this, so I asked)


Nairobi has pretty good medical facilities though. We fly in from neighboring Uganda.


Get well soon!


You're quite lucky that you could afford that hospital trip. In the US, it would typically go like "My doctor made some tests and he said that it doesn't look like a heart attack but something is wrong with one of the lines on my ECG. He asked me if its ok to call the ambulance for doing more checks at the hospital. I said no, I can't afford that. So I died four weeks later."

This isn't an exaggeration. Many people live paycheck to paycheck and can't afford the thousands of dollars a hospital trip would entail.


My mother was a nurse for 20 years. She was extremely good at her job and worked in the ICU unit of Vanderbilt Hospital. One day she had a severe headache at home and once it subsided she sent me an email detailing five possible causes. Every item on the list was trivial except the fifth item which said "small aneurysm bleed". I, along with the rest of the family, asked her to go to the hospital but she refused because she did not want to burden the family with a $5,000+ CAT scan and hefty doctor expenses over what she insisted was a just an overreaction to a bad migraine. I assumed, because she was such a good nurse, that she knew best. I ended up moving near her soon after and had the privilege of spending many days with her and my brothers as a family until I received a phone call one night telling me she was rushed to the hospital. When I arrived at the hospital a clerk attempted to block my way to fill out insurance paperwork, I rushed by her and headed to the ICU. When I arrived to the ICU I was told the aneurysm had applied too much pressure to her brain, the doctor said there was no chance of recovery. Even in death she still helped others, her organs saved two other individuals that day. In my home upon my desk I have a photo of my mother and I, a print out of her email, an award she received for being one of the first volunteer nurses to arrive in Louisiana after Hurricane Katrina, and a big pile of bills (ambulance ride, doctor examination, bed and care costs, etc).

Yes, I would agree, most people do not go to the hospital in the USA unless they are 100% positive it is required. This prevents many early visits to the doctor. People will often wait until the very last moment to get help.


How fucked up is that? I teared a little as i read your story. I can't imagine a mother not getting help for the sake of a measly 5000$. What kind of a society is the US if it lets its people die because they can't cough up a $ 5k medical fee? I had a very visceral reaction as i read your story.

May your mother rest in peace. tears in my eyes


This is an exaggeration, and it's an unfortunate one, since it distracts from the truth of what you're saying.

As many have pointed out, a person who chose to be taken to the hospital would be taken to the hospital and treated whether they could pay for it or not. The result of this would be a serious amount of debt, but likely could be paid down with a monthly payment. The worst case scenario is bankruptcy, which sucks (though it sucks much less if you're already poor and have no credit to destroy). Best case scenario, is that you make a lot of sacrifices, cope with making the monthly payments for many years, and eventually become debt free again. Like I said: best case scenario.

I think that anyone would agree, though, that either outcome is far better than dying young. (Also note that none of these scenarios includes going to prison for failure to pay your debts. There is no such thing in the U.S. legal system, except for certain debts owed to the U.S. government, and even this situation is rare and typically involves willful failure to pay, not mere inability. Private debts are just that: private.)

The real problem is that people in the U.S. are forced to make this sort of choice -- i.e., the choice between healthcare and basic material comfort. An ancillary problem is that people believe the myths that you're perpetuating -- if they think they won't be treated, or that they will go to jail if they don't pay, they may avoid treatment and die, essentially, only out of ignorance. This wouldn't be their fault. This would be the fault of a healthcare system that sends all the wrong signals, and secondarily the fault of the people who spread half truths about the healthcare system to score political points. (And I say this as an ObamaCare supporting, lifelong democrat.)


People will weigh the risk/benefit differently if there is a large cost involved. A doctor says "everything seems to be fine, but I'd like you to go to the hospital to be on the safe side." If you have good insurance or socialized healthcare, there is no question -- you will go to the hospital and get checked out. There is no reason not to, and it could save your life. If you have no insurance, then the question becomes "is it worth the certainty of a huge expense, for a small chance that I have a disease?"

Everyone has a threshold of what they consider serious enough to warrant a hospital visit. When you introduce massive expenses you shift that threshold upwards, which means missed diagnoses and an increase in avoidable deaths.


Which part is an exaggeration? The death? Hardly. It usually takes some time to get someone to an emergency room, so if their heart fully clogs, the outcome is often death.

Or that people will usually forego seeking treatment because they can't afford to rack up huge bills? Again, not really an exaggeration. If you have a house that you live in with your spouse and child, then you need that house, and people will often make decisions with the best chance of preserving it. If you go bankrupt, you can lose your house except in some specific circumstances (http://www.nolo.com/legal-encyclopedia/lose-home-file-chapte...).

It's easy to forget, as programmers, that most people don't enjoy the same benefits we do. Most people are living paycheck to paycheck with little savings and children.


It is an exagerration to say that the situation you described was typical (though "too common" might fit). You implied that you could not obtain treatment if you cannot afford it. And now you're adding the largely fictional risk of losing your home into the mix. Yes, it is possible to lose your home in bankruptcy but only if the equity in your home exceeds your state's homestead exemption (often, but not always, $50,000) by an amount large enough to make it worth selling. This will not often be the case for a person who is driven into bankruptcy by medical bills.

I do agree (as I said) that people should not be put in the situation of having to choose between preserving the lives they have built for themselves, and obtaining healthcare. But I think it's important to be scrupulously accurate and responsible on this topic since the discussion itself could influence somebody's decision not to seek treatment.


The important thing to note here is that the scaremongering is precisely what contributes to more deaths.

If you're marching around saying lives will be ruined if you seek treatment , then YOU, not some other person, are the problem.

Think carefully if the point you imagine you're making is worth that.


Right. I'm "scaremongering" by explaining the situation faced by many middle class families in the US on a forum for programmers, and I'm personally contributing to more deaths, not the poor healthcare system. Okay.

While it's true you may not lose your house (which I clearly articulated in my previous comment), there's more to life than a house. If you can't drive to work because you no longer have a car, then that's a huge problem. If you're putting your children through school, then suddenly you're jeopardizing their life by seeking to preserve your own unless the doctors know quickly and precisely what's wrong with you.

I don't understand why this is so controversial: People make suboptimal decisions, especially when the choices don't have clear outcomes. Here's some evidence that this actually happens in practice: https://news.ycombinator.com/item?id=8551522


I am similarly perplexed about why this argument is dragging on. This position:

> People make suboptimal decisions, especially when the choices don't have clear outcomes.

Is nuanced and, I think, correct. But your original comment didn't clearly say this (though now that I know your actual position, I'm able to read back and see what you meant). It sounded like you were saying -- like many other people -- that if you don't have insurance in the U.S. you can't get treatment, so you die.

Distinguishing between the two is important because to the extent that the latter view is perpetuated, it is a major reason why people "make suboptimal decisions."

I suspect that you and I have the same views about healthcare in America. I'm simply trying to get you to tighten up your somewhat loose talk about it. Things are bad, but you seem hell bent on making things sound even worse than they are. This impulse itself is harmful for precisely the reason that I and waterlesscloud have now both pointed out to you.

Case in point: did you know that there is also an automobile exemption in Chapter 7 bankruptcy that works similarly to the homestead exemption?


Yes. You're scaremongering. You're (by your own admission) using an extreme situation to make a point.

If you choose to emphasize this extreme situation, as you did, then yes, you own some personal responsibility.

If you don't like that, then don't use extreme cases to make whatever point you want to make.


Hm. Actually, I think I love it. I'm going to go out of my way to use the most extreme situations in order to contribute to as many deaths as possible, simply by having conversations on the internet. Bonus points if my rhetoric influences the death of a small malnourished Dachshund. Thank you for pointing out my previously-unknown power over life and death. This is awesome!

You're (by your own admission) using an extreme situation to make a point.

No, the situations aren't extreme. Like I said, people typically live paycheck to paycheck and can't afford trips to the hospital. The fact that someone on HN had direct evidence of this shows us how common the situation actually is. We should choose not to like that, and do something about it through voting.


If you're marching around saying lives will be ruined if you seek treatment

But lives are often ruined when people seek treatment, given that medical bills are the largest single cause of personal bankruptcy in the US. I don't think people get scared of seeking treatment because of the number of people pointing this out, as much as they get scared because of the number of bankruptcies.


>And now you're adding the largely fictional risk of losing your home into the mix. Yes, it is possible to lose your home in bankruptcy but only if the equity in your home exceeds your state's homestead exemption (often, but not always, $50,000) by an amount large enough to make it worth selling.

So what about this is fiction? As the proud owner of a 1-million-dollar spinal cord injury treated within the US, I don't understand where the fiction starts. Also, I was insured.

(also, is 'largely fiction' synonymous with 'rarely'?)

"The risk of a head-on-collision during city driving is largely fictional." doesn't sound quite right.


I have met two people in my life with over $250,000 in medical debt. Both were under 30, and neither had a job paying over $15/hr. They each seemed to be doing alright but had accepted that the medical debt was something they would never pay off. They both still needed infrequent care, and one of them was still building his debt faster than his income could keep up with.

I didn't know what to think, and still don't.


The two people should just leave the United States, start a life elsewhere. Argentina, Germany, Thailand, whatever.

I suggest the same thing to folks with unmanageable student loan debts with no clear answer in sight.

I think it's unfair for society to have burdened such debts on people who didn't know any better, who weren't equipped with the resources or the knowledge to make the right decisions. What do you do? Be 'unfair to society right back, don't pay, get away, start over again somewhere else.


So, run out of money - steal? That's hardly moral. Its part of the entitled "I'm so sad I got into this hole, and somebody should let me out" culture.


> So, run out of money - steal?

Pretty much. Though, compared with how corporations are fucking over little people left and right, it's hardly unwarranted.

This is not an unfamiliar story. There are people who did everything right, were kind and philanthropic their entire life, more than they should have been probably, but they find their whole lives suddenly ruined with just one accident. There are supposed to be certain trade-offs in a society, when one agreed to a social contract that they'll be nice to everyone, be law-abiding, pay their taxes which in part fund medical research, fund creation of roads and infrastructure that enable corporations to function and rake in money, etc., they expected for the system to be there for them in return when they had a time of sudden misfortune. If it's not there, I say fuck it, this is then time they also stop playing nice.


Straw man. This dude was suggesting dumping your student loans. I can guess that there are good reasons for that, but I didn't hear any.


The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread. - Anatole France


You would be surprised to know that hospitals would treat the person with the cheapest drugs and not do the major heart surgery. Not all hospitals, mind you, I know Mt Sinai (NYC) will most likely treat the person fully, but some will give enough heart meds to make the person feel "okay" until he/she dies.

Also, often after treatment, hospitals will just write the treatment as a "loss" and get a tax break. I've had friends pay $20 for a broken arm fixed. The problem is that many will give sub-par treatment, won't do the surgery, etc.

American health care system is an atrocity.


Yes, there are cases where things are worse than I described. But the comment I was responding to, and thus my comment, was addressed to what is "typical" in the U.S. system. What's typical, is that a person has insurance, goes to the hospital, and everything is more or less fine. What is not typical, but still entirely too common, is that an uninsured patient takes on an obscene amount of debt that has a major impact detrimental impact on his life. But that is far better than dying, which many would have you believe is the only option.

It is also true that people sometimes get this calculation wrong and die as a result. This is due, as I mentioned, to a system that inhumanely forces this choice upon you, as well as people who spread misinformation about how our system works.


Actually we ALL pay for their treatment. In Florida, if you have no insurance you are taken to the closest public hospital (county hospital). They treat you (barely - don't expect a private room). If you can't afford to deal with the bill, the county pays. And then we all pay via taxes.

It's a serious problem.


Part of the reason I believe people think they won't be treated is because that is very much the perception given to them by the front office staff of most hospitals and clinics. I'm not sure if this is what you are referring to when you say "the fault of a healthcare system that sends all the wrong signals", but I hope it is, and I feel it deserves a stronger highlight as the root of the problem.

The gentleman up-thread mentioned that when he went to visit his mother in ICU, he had to actively dodge the front desk person who wanted to discuss payment with him rather than letting him spend the last few minutes of his mother's life in her presence.

In the 90s, when I drove myself to the hospital suffering from appendicitis and I collapsed in the ambulance driveway trying to walk into the ER, since I was still lucid, albeit in pain, they felt it was more important to wheel me in to the billing booth and secure payment by taking all my available credit card information than to send me straight back to the examination room. They sounded quite pleasant and convincing that they were doing everything they could to get me seen right away, and they were very helpful in that they could just take the cards and write down the information after I was sent back, I just had to scrawl my signature on the release forms to get it started. It took me a decade to pay off that debt while avoiding bankruptcy and almost another decade to get my credit rating back up to a level that I could apply for some small bit of credit without fear of getting nasty looks from the person processing the application as a deadbeat.

While rationally, anyone would agree that either outcome is better than dying young, our society has become twisted in on itself in such a way that it is very easy to miss being rational when looking at the huge inconvenience and stress involved in incurring that cost versus the irrational hope that it is something small and it will pass on its own.


You are wrong. I have actually had a doctor check something and then ask which health insurance I had before recomending a follow up examination (which actually revealed something serious).

If I had had lesser insurance and he had left me with a "it's probably fine", I might indeed be dead now as with the op.


You're conflating two different things: the inclusion of price as a factor in medical decision-making, and hospitals' refusing to provide needed care to people who cannot pay.

The former, I agree, is a real problem (as I have now said repeatedly). The latter is generally a myth perpetuated by irresponsible people who want to score cheap points in the healthcare policy debate.


If whether someone has medical tests recommended by their doctor is based on their level of insurance, then that is refusing care to those who cannot pay.


As soon as price enters the equation, you're not going to maximize your life expectancy. This is math.

> I think that anyone would agree, though, that either outcome is far better than dying young.

Right, but how can you be sure? Doctors are clearly overly precautions because they don't want true negatives. In some cases (e.g. if you need to support kids) it may be reasonable to risk that.


I don't really want to wade into a political argument about health care, but this one specific part:

> The worst case scenario is bankruptcy, which sucks (though it sucks much less if you're already poor and have no credit to destroy).

Even though you immediately followed it with kind of a "but", I think you're seriously underestimating the effects of debt on someone in the U.S.

I have struggled financially for over a decade, after a period of doing really well. I could spend hours talking about the consequences of being poor (in U.S. terms).

1. Your housing options automatically become drastically limited. If you have bad credit, you don't get to pick and choose apartments or rental houses; you're more likely to end up in shared living arrangements or in the kind of apartment complexes that are willing to house people with bad credit, which also means your stuff is more likely to be stolen -- stuff that you can't afford to replace. (Having a load of laundry stolen was a hardship for me for about a year.)

2. Your employment options also become more limited. A lot of jobs, especially those that pay well, now do cursory background and credit checks as a proxy for judging whether or not you might try to rip them off. That of course makes it even harder to pay off your debt.

3. Forget about having reliable transportation. I've gone through 9 cars in less than 15 years: from one junker to the next. Used car prices are insane right now, so you're going to be stuck with someone's $500 or $1000 mechanic's special -- because that's all the cash you've managed to scrape together -- or you'll be doing a lot of walking and public transportation, neither of which are terribly convenient in most places in the U.S., which again limits your job options.

4. That beater you drive, if you drive one, becomes a target for law enforcement. They are most interested in cars that look like their registration may not be current, look like they may be a road hazard, look like they may be driven by a college kid with marijuana under the seat, look like they have a broken window ... the increased scrutiny is not only irritating, it can get expensive too, depending on just how poor you are.

5. Because your finances are limited by a lower-paying job, you're more likely to lack access to higher education, better quality food, or healthy hobbies.

6. You end up paying more for everything. You don't get to take advantage of discounts (for example, paying 12 months of insurance up-front), and if you do have any credit cards, you'll pay more on their rates.

7. If you don't have credit cards, every unexpected personal financial problem becomes a disaster. Oh, your radiator just blew a seam? Well, I guess you won't be driving anywhere for a while.

I'll stop there. Anyway, I don't completely disagree with you, but let's not just skip over the consequences of having a lot of debt. They can be really serious and long-term and dramatically change the quality of life someone has -- for the rest of their life.


Couldn't this whole thread just be about wishing 'mindcrime' a speedy recovery and healthy future, rather than wading into politics?


Not really a reasonable expectation, unfortunately. To discuss stories of "I know this other person who also similarly fell sick" and "The current system is so bad if you get into trouble, X,Y, and Z should be different for better results" is very much a part of the coping and mourning process. And of course we wish mindcrime a speedy recovery.


Fair enough.

@mindcrime -- I am so happy to hear that you got fast treatment and that you seem to be doing alright. I hope that you bounce back quickly and that you are able to look back on this as a brief dip in an otherwise rich and rewarding life.


About 16%[1][2] of Americans don't have health insurance. While the situation you describe is tragic and too common, it is a gross exaggeration to say it's "typical." Someone unfamiliar with the United States would read what you wrote and assume that this is the usual situation, when in fact it is relatively rare.

Should something be done to help that 16%? Yes, of course. Is it common? No.

[1] http://www.gallup.com/poll/168248/uninsured-rate-lowest-2008... [2] http://www.census.gov/content/dam/Census/library/publication...


It is often typical for those with health insurance. Back in 2009, 75% of the families bankrupted by medical bills in the US had health insurance.

http://www.reuters.com/article/2009/06/04/us-healthcare-bank...


This does not tell us that it's "typical" for those with health insurance in any sense. It tells us only that bankrupcies of insured people are often caused by health bills. This does not imply the inverse, that insured people's health bills often cause bankruptcies.

This is reasoning backwards: you are starting with the conclusion you'd like to see (that bankruptcy is typical for people with health insurance), then trying to adapt the evidence to fit that conclusion. Let's try it the other way around, looking at the data first, and then drawing conclusions:

There were about 1 million non-business bankruptcies in the US in 2013[1]. Reuters says that 60% of them were caused by health bills, and of those, 75% had insurance. Taking the bankruptcy and the Reuters figures at face value, this gives us about (1m * 60%) = 600,000 bankruptcies due to medical bills in the US annually; and of those, (600k * 75%)=450k had health insurance.

Going by the earlier Census.gov figure that 16% of Americans are uninsured, and a US population of about 316 million[2], this means that about 265 million Americans have health insurance.

We can then calculate that of those American who have health insurance, only 0.17% (450k/265m) wind up in bankruptcy due to medical bills; in other words, 99.83% of Americans with health insurance do not wind up in bankruptcy.

I think we can thus safely say that it is definitely not typical for an American with health insurance to wind up in bankruptcy due to health bills. It does happen, but it's very rare.

[1] http://news.uscourts.gov/bankruptcy-filings-drop-12-percent-...

[2] http://www.census.gov/popclock/


That's the yearly percentage, not the lifetime percentage. The chance of something happening to someone in a given year is vastly smaller than the chance of something happening to someone during their life.

So if 600,000 medical bankruptcies a year happen, how does that compare to other yearly numbers? Well, there are about 4 million births a year in the USA, so someone being born in the USA happens only 7 times more often than someone becoming bankrupt through medical bills.

It may have been slightly inaccurate to use the word typical, however these figures seem to indicate that it is at least fairly common.


That's a peculiar interpretation of 16%.

Something that is true for 1 in every 6 people surely isn't a rare event.


I said it is "relatively rare"; it is definitely not "typical," as the original poster wrote.


It's a partial truth though, right? There is a system for emergency healthcare for those without even medical insurance, isn't there?

Also, wouldn't you "just" get treated, rack up a bill and then go to prison for non-payment - guess that might be worse than dying?


There is, but people only use it in emergency situations. Getting someone to the emergency room usually takes at least 10 minutes, so if the artery clogs 100%, it often results in death. The key factor in the above scenario was the exploratory treatment to figure out what was wrong, and discover the 99% clogged artery. Such treatment is possible in the US, but it will definitely rack up a huge bill if you decide to pursue it. You won't go to prison for nonpayment, but it's possible you'll lose your assets. And if your dependents need those assets, like a house, it's easy to make the "wrong" choice of avoiding treatment unless doctors know exactly what the problem is.

Health insurance is ostensibly for this type of situation, but in reality if you're going to the hospital because "There's something wrong with me but nobody knows what," then the fear of insurance companies not covering it is very real. I don't know if they're legally allowed not to cover it in that scenario, but people have been screwed so often by insurance companies that the default decision making calculus is usually to assume the insurance company won't pay for anything.

This all assumes that you're someone with a relatively standard job and life. If you're lucky enough to have good health insurance and a fair amount of savings, then none of this applies, of course, since you can just get treatment in the same way as the parent commenter.


>It's a partial truth though, right? There is a system for emergency healthcare for those without even medical insurance, isn't there?

yes

>Also, wouldn't you "just" get treated, rack up a bill and then go to prison for non-payment - guess that might be worse than dying?

yes, but you don't go to prison. the only entity you can go to prison for not paying is the government. instead you will go through bankruptcy, in which all of your assets will be taken and your wages will be garnished for some period of time.


You would absolutely be treated. That's a requirement the federal government makes of any hospital that receives medicare/medicaid payment (if you're interested in learning more, google 'EMTALA').

You will also absolutely get a bill, which could be quite large, and could be sent to collections, and could destroy your credit history.

While those last three aren't certain, they're common enough that they should give you pause to think...


Note that EMTALA only requires hospitals to give you stabilizing treatment.


A reasonable person knowing that they would die without treatment would surely take the enormous debt.

But the problem is that "feeling some pain in your chest" is a long way from knowing that death is certain. And if your habit is to avoid going to the doctor because you know the bills could ruin your life, then your default will be "I'm fine!" As the OP made clear, getting to the hospital quickly can be the difference between life and death.

I just did a quick Google search, and a reasonable estimate puts the number of deaths from not having insurance in the same ballpark as gun deaths or car deaths: http://www.pnhp.org/news/2008/january/make_that_22000_uni.ph...


"A reasonable person knowing that they would die without treatment would surely take the enormous debt."

Single guy detected. Nothing wrong with that, just saying. Its a balance, lifelong economic death penalty for the three of them, vs they get to hang around with me for a couple decades... in the homeless shelter.

And that's assuming treatment means a cure. Most of the time, especially when the Drs are "mystified", all treatment means is the survivors are much poorer.

Currently I have great insurance, although that'll end soon enough, making these kind of balance decisions interesting in the future.


Excellent point. I hadn't thought about that.


  > A reasonable person knowing that they would die without treatment would surely take the enormous debt.
If there's nobody depending on you? Yes, you're right.

But suppose your family is depending on you. If you die, they get a decent life insurance payment. If you live but rack up crippling debt, maybe they lose the house and the cars and now nobody can pay for the kids' education.

Choice gets a little murkier then.


In many cases you don't know. You have a suspicion. It is probably nothing. Nope, it was something. Don't underestimate the human capacity for denial.

On top of that you have interesting incentives that you get to think about with your doctor: are they recommending this treatment to make more money?


You would go to the hospital, get treated and, if you couldn't pay the bills, declare medical bankruptcy. It sucks, but not it's not people dying in the streets or going to debtor's prison either.


The US doesn't have debtor's prison. One would simply have a potentially staggering amount of debt with which to deal.


You say this as if being in debt and unable to make the payments, is no big deal. Getting calls from aggressive debt collectors at work, at home, on my cell, even to relatives and coworkers, is a form of "debtor's prison".

When I asked for breakdowns of the debt itself, which I'm allowed to do under the FDCPA, I rarely got a breakdown of the total debt. One company responded to my request by serving me papers and filing a lawsuit. When I hired a lawyer to intervene and respond to the lawsuit, they dropped the lawsuit a couple of days before the date.

So the constant harassment, threats and stressors of being in over your head, is a kind of debtor's prison.


Getting calls from aggressive debt collectors at work, at home, on my cell, even to relatives and coworkers, is a form of "debtor's prison"

Well, have I got great news for you! There is this thing called the Fair Debt Collection Practices Act. Here it is:

http://www.ftc.gov/enforcement/rules/rulemaking-regulatory-r...

Want to stop calls to your work, at home, on your cell and even to your relatives and coworkers? Send them one registered letter telling them to stop calling you. Instantly gone. Why?

Because every single call they make to you about this debt after that one letter means they owe you $1,000 in statutory damages. When you sue them they even have to pay your attorney's fees so there are a million attorneys willing to take these cases for contingency!

Here's a quick write-up of what you can do for the harassment you described:

http://www.nolo.com/legal-encyclopedia/what-can-you-do-if-de...

Frankly, if you've been living in a "debtor's prison" like you've described, I'm assuming you haven't lifted a single finger to get out of it because this information is widely known in the U.S.


Did you even read my post? I mentioned the FDCPA. I'm very well aware of what my rights are under it. Most of the companies I dealt with didn't give a shit about it and simply passed my debts along to different companies who each got to take a whoops and pass it on again..


It's clear you didn't read the post you replied to.

Check your political response reflex. It might be too hair-trigger.


You've put words in my mouth and then battered a straw man; if something is "staggering" it is quite serious/severe.

A rephrasing might be "no, you won't go to prison, but will be made miserable via other methods."


I have cyclothymia and panic attacks, and these issues were worst at 25-27. At that time, I worked for a startup and had no insurance. (Now I have shitty insurance, but that's a world better than none.) Of course, panic attacks are brilliant and creative in their ability to throw weird symptoms (phantom smells were my "favorite") and every time, I'd worry about the (small) chance that "this time" it was a physical health problem, which I couldn't afford to have. I still have a brutal (and, objectively, unreasonable) fear of hospitals. It's not so bad that I wouldn't go if I needed to, but even if it's to visit someone who's fine, it takes serious chemical assistance. I can take on a cross-country plane ride without klonopin (hell, most "normal" people in the professional world can't do that, these days; granted, that has more to do with yuppies being pussies than a real anxiety condition, though) and doctor's offices are fine, but hospitals... fuck. Too many horrible memories.

There are some great individual doctors and nurses, for sure, but our mean-spirited, psychotic medical/insurance system taps into this deep-seated fear that humans have of being abandoned. Abandonment is a more vicious fear than death, for most of us. Death (when it comes peacefully; granted, that's not as common as we'd like to believe) is either nonexistence or something that's probably very interesting.

To answer your question, you can go to the ER and get treatment without insurance, but that's not going to get you preventative heart surgery or cancer treatment. If you get cancer, you can't walk into an ER and demand chemo. For plenty of Americans with cancer, their first medical attention is when the fucking thing throws a clot or causes organ failure and it's past too late.

You won't go to prison for non-payment, but you will get a huge bill, because while insurance companies are good at negotiating medical bills, you can't. If you can't pay it (and U.S. medical bills can easily top $10,000 for a routine ER visit) then you can be taken to court, have a judgment against you, and end up with your credit destroyed (there's nothing on your credit report to say that the cause of your debt or bankruptcy is a black-swan medical event, or even medical at all) and your wages garnished.

It's not like these horror stories are common, but they certainly happen and most Americans know someone who's been involved in one. It's not like 25-year-olds dying on the street due to our bad medical system is a common event, but it is a terrible system that ruins lives on a fairly regular basis. The sword of Damocles hangs over all of us. Even with insurance, it's easy to get fucked. Michael Moore's Sicko (whatever you think of him, that documentary was incredibly well-researched and important) was about people who had insurance.


> I have cyclothymia and panic attacks, and these issues were worst at 25-27.

Weird. I had my first panic attack at 25, nearly 26. The medical folks thought I was having a heart attack at first, but the symptoms and tests didn't quite add up. Fortunately, I've been able to manage it reasonably well with the help of my GP, but I do occasionally have recurring episodes if I don't take care to avoid triggers (my fault, really, I'm bad about that sort of thing).

Oddly, reading this makes me feel better knowing that there's someone else who had the same thing happen in the same age range. What's funny is that you know in the back of your mind you're not a statistical outlier, but when you don't know anyone in your immediate circle who suffers from the malady, you can almost convince yourself there's something horribly wrong. ;)

I never did get the phantom smells, but it often expresses itself differently for different people.

Cheers, mate.


I know how you feel, went through the same thing. Stress is a killer, and combined with poor health, even more lethal.


He is in the US? UNC Chapel Hill hospital?


Yes.


This is right, I started working for my uncle and had to shift bags of peat at a plant nursery at around 14, because of it I over developed chest muscles that caused me to have my first of about 4 'heart attacks' at around 17. It was caused by the muscles in my chest squeezing the heart and forcing it to stop briefly. Kinda puts me on my ass, but I can feel is still to this day and now understand how to relax when i feel it begin to come on (I'm 31 now and still kicking)


Glad you're OK. Rest up and feel better.

This is a good reminder for all of us with sedentary jobs to be active and get/stay healthy.


I just ate a dry muffin. Just wanted to let you all know that if you encounter a dry muffin, here's what you do: make sure you have milk or coffee handy.


What kind of person creates an account just to be a dick about somebody's heart attack?


I call them special. You know, like special kids.


Nobody believes you.

You care only when it serves your selfish interests.




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