Chest Pain

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.

Stephen Bittner Sr., thought he was having heartburn, a whole week of heartburn, heartburn so severe his wife kept asking, "Are you all right?" while he kept popping Rolaids and aspirin and telling her he was fine.An insurance agent, the 53-year-old man should have known better: He had already lost two brothers to heart disease, and another had undergone bypass surgery. "But I just didn't think it would happen to me," he says. "I thought I was too young."Besides, the pain wasn't constant; he'd take the pills and eventually it would go away -- "except that this one particular day, it didn't go away, and my wife insisted that I go to the hospital," he recalls.

Lauri Vidil had her first episode of chest pain eight years ago, when she was at Penn State University. It was severe enough to send her to the local emergency room."

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.

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.

Three days before Thanksgiving 1986, Jay H. Mandell -- a 43-year-old Pikesville business executive -- was struck by severe chest pain as he drove home from work. The pain radiated to his left arm and was so excruciating that he was forced to pull off the road.Within the next two days, two doctors told Mandell, the owner of an office and building maintenance company, not to worry. They gave him antacid pills. They said he had indigestion.On Thanksgiving Day, after repeated calls reporting his worsening condition to his physician, Dr. Stephen Glasser, Mandell drove himself to Sinai Hospital.

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.

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.

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?

ANNAPOLIS -- Gov. William Donald Schaefer left the cardiac unit of Johns Hopkins Hospital yesterday in good spirits after doctors found no evidence that the dull chest pains he had been feeling stemmed from a heart problem or any other serious ailment.During his 24-hour stay, doctors performed numerous tests and ruled out the possibility of a heart attack or any underlying heart ailments that could predispose him to one, said Dr. James D'Orta, a personal friend who accompanied the governor to and from the hospital.