Chest Pain

Downing dozens of nitroglycerin pills and fighting chest pain, the woman from Delaware and the man from Kentucky each arrived at Johns Hopkins Hospital last fall. They were patients Nos. 1 and 2 in an experimental heart treatment, sick people eager to grab their last chance at a normal life.Between them, they could count dozens of hospitalizations, 26 cardiac catheterizations, nine angioplasties and five bypass surgeries. Each had suffered a heart attack, and each had become resigned to a life alone.

NEW YORK -- Cataloging a succession of omissions and errors, New York state health officials leveled fines and unusually harsh criticism yesterday at two New York City hospitals for deficiencies in their emergency-room treatment of the playwright Jonathan Larson in the days before his death earlier this year.Twice during the last week of January, Larson, 35, who created the hit musical "Rent," was rushed to emergency rooms complaining of severe chest pain. Twice, doctors failed to diagnose the potentially treatable condition that killed him, a four-month investigation by the State Health Department has found.

For five weeks her chest ached, but Rosalie Geisler, 55, did her darndest to ignore it. Then, in the middle of the night, a sharp pain woke her. By morning, it marched down her left arm, leaving her fingertips almost numb.Mrs. Geisler put it out of her mind and left for her manager's job at the Cake Cottage in Perry Hall. Later, her worried husband arrived with doctor's orders to take her to the hospital."I didn't want to come," she says after a team of nurses at St. Joseph Hospital descend on her to hook her up to a heart monitor.

Q: We read it's essential to get immediate medical attention at the first sign of a heart attack. It would be easier to follow this advice if I knew what to expect if I have a heart attack.A: A heart attack or myocardial infarction occurs when one of the blood vessels to the heart (coronary arteries) becomes completely blocked. Many heart attack victims have a history of chest pain (angina) that may worsen or occur more often in days before an attack. Others have ill-defined warning symptoms, or experience a heart attack suddenly, without any premonition.

To compete in triathlons, you have to train for three sports: running, cycling and swimming. If you train too much, you won't be able to compete effectively. Training too much tires your muscles and prevents you from training at near-maximum intensity at least once a week in each sport. You need to train intensely to improve your coordination at fast speeds so your muscles will be more efficient and you will have greater %o endurance.Some triathletes with an extraordinary ability to take in and use oxygen can't compete well in events in which they have poor form.

According to the legend, Damocles was invited to a sumptuous banquet by Dionysius, the tyrant of Syracuse, who wanted to show him the impermanence of happiness. The food was wonderful, but hanging over Damocles' head was a sword, suspended by a horsehair, ready to drop at any moment. Needless to say, he did not enjoy the evening.It is much the same with the end of life. After exhausting our appointed threescore years and ten, there comes a time when we must be ushered out of this world. The question is -- how?

Exercising in cold weather can cause chest pain in some people who have no problems when they exercise in warm weather. When cold wind blows in your face, your heart rate slows down. This decreases the blood flow to the heart and can cause pain.If the heart muscle is unable to get all the oxygen it needs, it starts to hurt.While freezing your face slows your heart, freezing your fingers makes your heart beat faster. If you have no history of arteriosclerosis and have chest pain when you exercise in cold weather, check with your doctor to rule out possible heart problems.

Q: I have always had a great fear of heart disease because my father died of a heart attack in his early 50s. In the year before his death he often complained of anginal chest pain. Although I am only 39, in recent weeks I have noted occasional episodes of chest pain and worry that they may be angina. How can I tell if my chest pain is due to heart disease?A: Coronary artery disease is the cause of angina pectoris -- a discomfort, usually in the chest, that is most often precipitated by physical activity and promptly relieved by rest.

I've heard it over and over again. A patient complains that there is just no time in the day to exercise; life is too jampacked with other priorities.But if you do it right, all you need is 36 minutes a week to become fit and stay that way. The key is to alternate between intense and easy exercises during your workouts. It's called interval training, and it works.Fitness means your heart is strong. To strengthen your heart, you have to exercise vigorously enough to raise your pulse rate by at least 20 beats per minute above your resting heart rate.

Many people jog for health and fitness. But if you think you're past that stage and are ready to try racing, here are a few rules:If you want to compete in a race, you have to learn to run at a very fast pace. But you can't train by running very fast for an extended distance or you'll tear your muscles.The best approach is to train by running intervals, which are multiple repeat runs of a shorter distance at race pace with brief rests between each run. Since moving very fast in sports can damage your muscles, you probably should not run intervals in training more than once or twice a week.

A reader of our Picture of Health blog asked recently how to distinguish the symptoms of heartburn from the symptoms of a heart attack. It turns out to be harder than you might think. Dr. Richard A. Desi, a gastroenterologist at the Institute for Digestive Health and Liver Disease at Baltimore's Mercy Medical Center, discussed how to tell the difference. "That's actually not a very easy question," Desi said. "It's a difficult question for patients and for doctors." One key, he said, is to look for what are considered the classic symptoms of each.

NEW YORK - Former President Bill Clinton sailed through quadruple bypass surgery yesterday in what surgeons called a routine but necessary operation to prevent a major heart attack. Doctors at New York-Presbyterian Hospital said Clinton could be released from the hospital in four or five days if initial recovery goes well, and that the signs looked good so far. At 4 p.m. yesterday, four hours after surgery, he was said to be under sedation but responding to commands. "He will gradually resume a normal routine of exercise and activity at home," said Dr. Allan Schwartz, chief of cardiology, who did not rule out Clinton's making campaign appearances before the November presidential election.

An article in Monday's Sun about dental problems that can result from oral piercings listed angina as one of several complications noted by doctors. The malady referred to was not angina pectoris - chest pain caused by insufficent blood supply to the heart - but Ludwig's angina, a potentially fatal infection of the neck that can close off a patient's airway.

WASHINGTON - Vice President Dick Cheney, who has suffered four heart attacks, checked himself into a hospital yesterday after complaining of chest pains and underwent surgery to clear a partially blocked artery. Doctors said Cheney would remain overnight at George Washington University Hospital and probably be released today. A White House spokesman said that Cheney and his doctors would then decide when the vice president will return to work. Dr. Jonathan Reiner, Cheney's cardiologist, said that "as of now," the vice president did not appear to have suffered another heart attack.

Howard County Circuit Judge Raymond J. Kane Jr. was admitted to Union Memorial Hospital in Baltimore yesterday after feeling chest pain this weekend, court officials said. Kane, the chief administrative judge for Howard County Circuit Court, is undergoing medical tests on his heart at Union Memorial and could be out for several weeks depending on test results, the officials said. Kane, 61, has been serving on the Howard County Circuit Court bench since 1982 and has been the administrative judge since 1991.

Downing dozens of nitroglycerin pills and fighting chest pain, the woman from Delaware and the man from Kentucky each arrived at Johns Hopkins Hospital last fall. They were patients Nos. 1 and 2 in an experimental heart treatment, sick people eager to grab their last chance at a normal life.Between them, they could count dozens of hospitalizations, 26 cardiac catheterizations, nine angioplasties and five bypass surgeries. Each had suffered a heart attack, and each had become resigned to a life alone.

NEW YORK -- Cataloging a succession of omissions and errors, New York state health officials leveled fines and unusually harsh criticism yesterday at two New York City hospitals for deficiencies in their emergency-room treatment of the playwright Jonathan Larson in the days before his death earlier this year.Twice during the last week of January, Larson, 35, who created the hit musical "Rent," was rushed to emergency rooms complaining of severe chest pain. Twice, doctors failed to diagnose the potentially treatable condition that killed him, a four-month investigation by the State Health Department has found.

For five weeks her chest ached, but Rosalie Geisler, 55, did her darndest to ignore it. Then, in the middle of the night, a sharp pain woke her. By morning, it marched down her left arm, leaving her fingertips almost numb.Mrs. Geisler put it out of her mind and left for her manager's job at the Cake Cottage in Perry Hall. Later, her worried husband arrived with doctor's orders to take her to the hospital."I didn't want to come," she says after a team of nurses at St. Joseph Hospital descend on her to hook her up to a heart monitor.

To compete in triathlons, you have to train for three sports: running, cycling and swimming. If you train too much, you won't be able to compete effectively. Training too much tires your muscles and prevents you from training at near-maximum intensity at least once a week in each sport. You need to train intensely to improve your coordination at fast speeds so your muscles will be more efficient and you will have greater %o endurance.Some triathletes with an extraordinary ability to take in and use oxygen can't compete well in events in which they have poor form.

According to the legend, Damocles was invited to a sumptuous banquet by Dionysius, the tyrant of Syracuse, who wanted to show him the impermanence of happiness. The food was wonderful, but hanging over Damocles' head was a sword, suspended by a horsehair, ready to drop at any moment. Needless to say, he did not enjoy the evening.It is much the same with the end of life. After exhausting our appointed threescore years and ten, there comes a time when we must be ushered out of this world. The question is -- how?