Where Have All the Elephants Gone?

Submitted by Dr. Eric Cook, D.O., EMS and Chest Pain Center Director, Franciscan St. Margaret Health.

During my training as an Emergency Medicine physician, I was taught to recognize a heart attack by certain symptoms. Shortness of breath, sweating, palpitations and the proverbial - "I have an elephant sitting on my chest" - are all recognized as symptoms of a heart attack.

Realizing that the faster one receives care when having a heart attack, accredited chest pain centers were developed to optimize care for the patient having a coronary event. As I move on in my career and care for more individuals who are experiencing a heart attack, I recognize the error of calling these centers "Chest Pain Centers."

People having a heart attack routinely arrive at the emergency department not complaining of chest pain. They complain of chest discomfort, fluttering, palpitations, uneasiness, dizziness, nausea, pain in their teeth, pain in their shoulder, new onset of fatigue with activity or walking stairs, or "I just don't feel right, doc." They don't complain of the dreaded "elephant on my chest." This is especially true of people with other medical problems such as diabetes.

Across the world, people wait at home 2 - 4 hours having a heart attack before seeking help. Many times the reason given is, "Doc, I didn't come in because I was not having pain."

I think our chest pain banner should read - Franciscan St. Margaret's Chest "discomfort, palpitations, fluttering, sweating, dizziness, fatigue, nauseated, shortness of breath, pain in the shoulder, I just don't feel right" center. If any of these symptoms are concerning you come in immediately and get checked out.

Remember, the elephant has left the building.