Understanding Chest Pain and Heart Attack


    Expert advice from Christian Witzke, director of the Structural Heart Disease Program at Einstein Medical Center in Philadelphia.

    Expert Advice from Einstein Healthcare Network

    With Dr. Christian Witzke, Director, Structural Heart Disease Program at Einstein Medical Center Philadelphia
    What are the symptoms of heart disease?
    “It depends what kind of heart disease is causing the problem,” Witzke says. “Coronary artery disease causes sudden chest pain. Classical angina also comes with pain radiating to the left arm or shoulder. Atypical angina creates shortness of breath that might be accompanied by back pain or pain in the chest.” Sudden sweatiness, dizziness and fainting are other signs of heart disease, Witzke says. “If you have any of these symptoms, see a cardiologist immediately.”
    What are the symptoms of heart attack?
    “Any chest pain that starts suddenly and lasts for a few minutes can signify a heart attack,” Witzke explains. “Call 911 immediately.”
    Is chest pressure the same as chest pain?
    This is the most common, deadliest mistake that people make, Witzke says.
    “People think of pain and imagine sharp pangs, but pressure is also pain. Many people who are in the process of having heart attacks say, ‘No I don’t have pain. I feel pressure.’ If you feel any kind of chest pain or pressure, get to a hospital immediately.” 
    The faster you get to a hospital, the more heart muscle can be saved. 
    “Unfortunately, a lot of patients ignore the signs of heart disease and heart attack,” Witzke says. “We have patients who say, ‘I’ve been having chest pain for 24 hours.’ By the time they get here, it may be too late to salvage any heart muscle. That can put them in a more serious state than they would have been had they come to us immediately.
    “Some heart muscle death occurs right away and the pains of that muscle death are the signs of a heart attack,” Witzke explains. “A good deal of that muscle can be restored. It’s a question of how long certain parts of the muscle have been deprived of blood and how quickly we can restore that blood flow.”
    What is coronary artery disease and how is it treated?
    “Normally, the heart has three arteries,” Witzke explains. “You can have blockage in all three or not. When you have a significant blockage, the treatment is open-heart surgery and creating bypasses.
    “Let’s say that you have a turnpike from Philadelphia to New York. If there is an accident on the turnpike, it goes from five lanes to two lanes. Fewer cars are getting through that blockage. It’s the same with blood flow, but we are talking about plaque, not cars.
    “The most common treatment is using a stent to push the blockage out of the way,” Witzke says. “If there is a lot of blockage, we build a new turnpike by taking a vein from the leg. That is bypass surgery.
    “There are many patients who are not candidates for open heart surgery because they have weak hearts,” he says. “For them, we use a stent and do a lot to support the heart muscle.”
    What is cardiogenic shock and how is it treated?
    “It is caused by major blockage that results in a large amount of heart muscle dying,” Witzke says. “It is a big chunk of your heart dying — as much as 30 percent to 40 percent. That affects your entire body. That is cardiogenic shock. It is a massive heart attack. The mortality can be as high as 80 percent. Unfortunately, we do not yet have ways to improve that survival rate. Our program at Einstein is meant to identify and treat those people earlier and help them sooner. The first step in that process is recognizing the warning signs of heart disease and getting to a cardiologist.”

    Christian Witzke, MD is director of the Structural Heart Disease Program at Einstein. He is board certified in interventional cardiology, cardiovascular medicine and internal medicine. Dr. Witzke completed his internal medicine residency and cardiovascular medicine fellowship training at Einstein and completed additional training at Massachusetts General Hospital and Harvard Medical School.