Heart Not Always the Culprit in Chest Pain : Health: Checking out the most serious possibility first, though, is wise, doctors say. Which is what they did with Deputy D.A. Hodgman.
When Deputy Dist. Atty. William Hodgman was rushed to the hospital Wednesday evening with chest pain, the possibility of a heart attack--though deemed unlikely as of Thursday afternoon--was first considered, and for good reason.
“Chest pain is not always caused by a heart attack, but considering this most serious possibility first is essential,” says Dr. David Cannom, medical director of cardiology at Good Samaritan Hospital and UCLA clinical professor of medicine.
That is especially true, he adds, if the patient is middle age and male. Other risk factors--high blood pressure, high cholesterol, lack of exercise and a history of smoking--increase the chances of chest pain being coronary-related, Cannom says.
“Certainly if a middle-aged person develops chest pain, one ought to think first of a heart condition--more so than if a 22-year-old college senior who’s been up for three nights studying for finals is complaining of chest pain,” Cannom says.
Hodgman, a key member of the O.J. Simpson prosecution team, is 41 and is said to be a regular runner and a nonsmoker.
Chest pain could also be related to anxiety or stress, says Dr. Jeffrey Hendel, a cardiologist at St. Vincent Medical Center. “Some people get headaches from stress, some get chest pain.”
Hodgman complained of chest pains during a trial strategy meeting Wednesday evening and was taken by paramedics to California Medical Center. Earlier in the day, he had left court visibly angry because of the addition of several witnesses by the defense. Medical tests are continuing.
When evaluating a patient with chest pain, an emergency-room doctor or cardiologist first evaluates risk factors with a goal of separating coronary-based pain from chest pain arising from other conditions. Among them: duodenal ulcer, hiatal hernia, blood clot in the lung and aortic dissection, a life-threatening condition in which the aorta tears.
The hospital cardiologist caring for Hodgman--Dr. Richard Hart--declined comment early Thursday. But Cannom says if there is chest pain and any suspicion on the doctor’s part of a heart problem, the following work-up is standard: an electrocardiogram to record the heart’s electrical activity; blood tests to detect enzymes that indicate damage to the heart muscle, and treadmill testing to help identify coronary artery vessel narrowing.
If these tests aren’t conclusive, an angiogram is often done.
Heart attack is more likely the root of the chest pain, Hendel says, if the pain lasts half an hour or more, although that’s not hard-and-fast.
