In light of the tragic passing of long time NFL and NCAA coach Tony Sparano on Sunday July 22nd, a quick review of chest pain seems to be timely and appropriate.
The first thing that needs to be said is chest pain is not a medical diagnosis. Chest pain is a symptom.
What does that mean?
It means it is treated by medical personnel like elevated blood pressure or an elevated temperature, a clue as to what maybe going on with a patient. When people hear chest pain most people assume this means heart attack, but in an emergency department/hospital setting heart attack or acute myocardial infarction as it is known in the medical community is only one of a whole list of conditions that include some type of chest pain as a symptom.
CHEST PAIN – Possible Diagnoses
- Acute Cardiac Syndrome – Acute Myocardial Infarction
- Chest Wall Pain – musculoskeletal pain that is reproducible when chest is palpated
- GERD – Gastroesophageal Reflux Disease (heartburn)
- Panic Disorder or Acute Anxiety Attack
- Pneumonia or Bronchitis
- Pericarditis – this is diagnosed based on the presence of a triad of symptoms and is not common
- Pulmonary Embolism – this is related to a blood clot in the lungs
- Heart Failure – generally occurs in patients with a history of previous myocardial infarction
Many people posted on various social media sites that Coach Sparano was admitted for chest pain and discharged the next day without proper diagnosis – and died 2 days later – so therefore the doctors didn’t do their job properly.
This is not an accurate assessment. The most likely scenario is that he was discharged because the initial workup was found to be negative. Based on current guidelines under which medical professionals are trained, the risk of remaining in the hospital was greater than the risk of an acute life threatening event occurring in the 24-72 hours after discharge.
Several algorithms are used but basically if the initial workup is negative, patients are discharged home with follow up for further testing as outpatients scheduled in the week following discharge. This testing can include advanced cardiac testing – and if deemed necessary – based on the results of these tests, more invasive procedures like cardiac catheterization and angioplasty may be performed.
Chest pain is a complex symptom. The loss of Coach Sparano was a shock to everyone, but if you experience the following symptoms, you should go to an emergency room, your family doctor (if you can be seen in a timely fashion), or call 911 so you can be evaluated as soon as possible:
- Chest pain associated with heavy sweating and/or worse with exertion
- Chest pain at age 40 or older with a family history of cardiac disease
- Chest pain with other conditions such as obesity, diabetes and/or hypertension
- Chest pain if you are a current or former smoker
- Chest pain after having a history of myocardial infarction (heart attack)
Coach Sparano apparently did exactly what he was supposed to do, but sometimes bad things happen to good people despite the best efforts to the contrary.
Finally, my heartfelt condolences go out to the Sparano family and Vikings fans everywhere. Rest in Peace, Coach Sparano, You will have a seat on the 50 yard line in heaven for eternity.
Editor’s babble: Initial diagnostic testing doesn’t always reveal cardiac problems or an ongoing “heart attack” (myocardial infarction) . My husband, a retired ER doctor, treated many patients experiencing cardiac symptoms where initial diagnostic testing failed to reveal acute myocardial infarction. If initial testing turns out negative, it’s standard protocol to follow up with a treadmill stress test (among others) and it’s likely Mr. Sparano was scheduled for follow up but died before it was performed. Thanks to Dr. Beth Sullivan for providing information explaining what may have happened in Coach Sparano’s case, but of course if an autopsy is done it will likely reveal exactly what happened. You can follow Beth on Twitter @GAPeachPolymer.