The Heart Pain Killer: How to Recognize the Signs of a Heart Attack and What to Do

In 2004, the drug maker Merck pulled rofecoxib (Vioxx) off the market, following revelations that the popular prescription painkiller increased the risk of heart attacks and strokes. That action triggered a closer look at drugs in the same class, known as nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs, which are widely used to ease pain, quell inflammation, and cool fevers, include over-the-counter drugs such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) and the prescription drug celecoxib (Celebrex).

The Heart Pain Killer

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Soon, all NSAIDs except aspirin were suspected of increasing heart attack risk. That prompted the FDA to mandate a warning about this side effect on all NSAID labels. Earlier this year, the agency considered dialing back the caution on naproxen, based on an analysis that showed a lower risk from naproxen compared with other NSAIDs. But a panel of expert advisers voted against the label change, so the warning remains the same for all NSAIDs.

Despite that decision, cardiologists often recommend naproxen over other NSAIDs, says Harvard professor Dr. Elliott Antman, a cardiologist at Brigham and Women's Hospital and lead author of guidelines on NSAID use published by the American Heart Association (AHA). "From a cardiovascular standpoint, naproxen may have the least risk," he says, acknowledging that the evidence to support that claim is weak. But for a person at risk for heart problems who also has arthritis or musculoskeletal discomfort and needs an NSAID, naproxen at the lowest possible dose is a reasonable choice.

If you have had a heart attack or been diagnosed with a heart condition and you also have pain from an injury or a chronic condition like arthritis, follow the AHA's stepwise approach to treating pain. They recommend starting with a nondrug approach such as heating pads, ice, or physical therapy, if appropriate. Even if these approaches don't eliminate your pain, they may let you take a lower dose of a painkiller.

Next, try aspirin or acetaminophen (Tylenol). Aspirin is the one NSAID that's actually good for the heart. But it can upset the stomach, lead to an ulcer, and cause bleeding in the digestive system. Acetaminophen appears safe for both your heart and gut. "But unlike NSAIDs, acetaminophen has no effect on inflammation, which is at the root of the arthritic conditions that plague many people," says Dr. Antman.

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While pain is the most common symptom of a heart problem, some people experience other symptoms, with or without chest pain. Women, in particular, may report atypical symptoms that are later identified as being the result of a heart condition:

Your doctor will ask you some questions, and your answers can help them diagnose the cause of your chest pain. Be prepared to discuss any related symptoms and to share information about any medications, treatments, or other medical conditions you may have.

However, chest pain can also be a symptom of a life threatening condition. Seek immediate medical treatment if you think you may be experiencing a heart attack or another heart problem. This can save your life.

Risk factors for heart attack are conditions or habits that make it more likely that you will get heart disease. Coronary artery disease (CAD) is the most common form of heart disease. Some of the risk factors for CAD can be controlled and others cannot.

People often think a heart attack and cardiac arrest are two names for the same thing. They are not. A heart attack can lead to cardiac arrest (also known as cardiopulmonary arrest), but they are two different conditions.

Angina is the medical term for chest pain or discomfort caused by a temporary disruption in the flow of blood and oxygen to the heart. It is not a heart attack. Angina pain usually goes away with rest or medication. It is also a warning sign that you are at increased risk for heart attack or cardiac arrest.

Henry tells Shots that diclofenac raises the risk of a cardiovascular "event" such as heart attack by about 40 percent, compared to taking no NSAID. Other NSAIDS are much safer, with naproxen being the least risky. Naproxen has a global market share of only 10 percent.

The bad cardiovascular risk profile of diclofenac is no secret. MedlinePlus, a U.S. government website, says people who take it "may have a higher risk of having a heart attack or a stroke" and that "these events may happen without warning and may cause death."

Countries where diclofenac dominates the painkiller market are largely low- and middle-income nations such as Bangladesh, Pakistan, Thailand and Vietnam. But the list also includes England, Australia and New Zealand. And the drug is number three among Canadian NSAIDs, with more than 17 percent of the market.

Henry says there's a perception that diclofenac is a more potent painkiller than other NSAIDs. "We think that's just because it's been marketed in high doses." Higher doses also magnify the cardiovascular risk.

Long-term use of NSAIDs can make your body hold onto fluid. This can make the symptoms of heart failure, such as shortness of breath, swollen ankles, and a rapid or irregular heartbeat, worse. NSAIDs can also keep the kidneys from working well. This makes taking NSAIDs risky for people who already have kidney disease.

There is no simple answer. The best painkiller to use depends on your health problems. It also depends on any other drugs you take. Be sure to tell your doctor about any prescription drugs, over-the-counter drugs, or herbal medicines you take.

Pain is a broad and complex area of healthcare. It covers short-term (acute) pain, such as headaches, pulled muscles and minor injuries, and long-term (chronic) pain, which can include inflammation of the joints.

However, some research indicates that almond consumption may help with the prevention of heart disease. Though almonds may not stop the immediate pain, they can have a positive impact on overall heart health.

Women should be aware that they are less likely to experience intense chest pain than men. They are more likely to have uncomfortable pressure or squeezing in their chest than pain. Women are also more likely to experience the other symptoms of a heart attack than a man.

Home remedies have a place in the effective treatment of often minor pain in the chest when the cause is known, and it is not a serious condition. On the other hand, any serious cases, such as a heart attack or angina, should be treated immediately by a medical professional.

Prescription painkiller overdoses* were responsible for more than 15,500 deaths in 2009. While all prescription painkillers have contributed to an increase in overdose deaths over the last decade, methadone has played a central role in the epidemic. More than 30% of prescription painkiller deaths involve methadone, even though only 2% of painkiller prescriptions are for this drug. Six times as many people died of methadone overdoses in 2009 than a decade before.

Heroin enters the brain rapidly and binds to opioid receptors on cells located in many areas, especially those involved in feelings of pain and pleasure and in controlling heart rate, sleeping, and breathing.

Prescription opioid pain medicines such as OxyContin and Vicodin have effects similar to heroin. Research suggests that misuse of these drugs may open the door to heroin use. Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin1-3 and about 80 percent of people who used heroin first misused prescription opioids.1-3 More recent data suggest that heroin is frequently the first opioid people use. In a study of those entering treatment for opioid use disorder, approximately one-third reported heroin as the first opioid they used regularly to get high.4

A fibrous sac known as the pericardium surrounds the heart. This sac is made of two thin layers with a small amount of fluid between them. This fluid reduces friction between the layers as they rub against each other when the heart beats. In some cases, too much fluid builds up between these two layers. This is called pericardial effusion. When this happens, it can affect the normal function of the heart. Pericardiocentesis drains this fluid and prevents future fluid buildup.

During pericardiocentesis, a doctor inserts a needle through the chest wall and into the tissue around the heart. Once the needle is inside the pericardium, the doctor inserts a long, thin tube called a catheter. The doctor uses the catheter to drain excess fluid. The catheter may come right out after the procedure. Or it may stay in place for several hours or overnight. This is to make sure all the fluid has drained, and to prevent fluid from building up again.

Many medical conditions can cause fluid to build up around the heart. This fluid buildup can cause shortness of breath and chest pain. This may be treatable with medicine. In other cases, this fluid buildup is life threatening and needs draining right away.

Pericardiocentesis is not the only method to remove fluid around the heart. However, it is preferred because it is less invasive than surgery. Sometimes doctors surgically drain the fluid. This may be done in people who have had chronic fluid buildup or inflammation, in people who might need part of the pericardium removed, or in people whose fluid has certain characteristics.

Your own risks may vary according to your age, your general health, and the reason for your procedure or type of surgery you have. They may also vary depending on the anatomy of the heart, fluid, and pericardium. Talk with your healthcare provider to find out what risks may apply to you.

A study from the Centers for Disease Control and Prevention (CDC) found that women who took NSAIDs and opioid pain medicines during early pregnancy were more likely to have babies affected with certain birth defects compared with women who took acetaminophen. However, more research is needed to understand whether the risk of birth defects is related to the medicine or to the conditions that they are being used to treat. More research is also needed to understand which medicines are the safest treatment options for pain management during various stages of pregnancy. 2ff7e9595c