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BEWARE
OF'SILENT''
CORONARIES IN WINTER
Winter
is
the season with high incidence
rates of
coronaries. Typical attacks have sudden crushing chest
pain
in
front, lasting for at least half-an-hour to several
hours
or even days. Unlike angina, the pain is
not
relieved by
resting or
taking of nitroglycerine administered
underneath
the tongue. The pain is
more
like
a
rock
sitting
in
front
of the chest; some patients may even have heavy sweating, pallor, intense fear
and
feeling of impending death. The sooner
the
patient is rushed to hospital,
the
higher
is
the chance of survival.
Unfortunately, some patients have "silent" coronaries and prompt treatment is often delayed due
to
the
failure
of
recognition
of
the
diagnosis.
ln China,
about
1/6
to
1/3
of coronaries are silent or atypical, e.9., the
pain
radiates toward the
tummy and
masquerade
as
"stomach pain";
when
radiation
is
towards
the neck,
it
masquerades as arthritis of
the
neck bones,
toothache, sore-throat,
etc. The
worse
is
that
10-20% of case,
there
is little pain; some cases are
completely
"silent",
with
no pain at
all
-
these
patients
are usually
rather
elderly or patients complicated
by
diabetes
-
they often have peripheral
neuritis
causing nerve
numbness
with poor sensation. They may
not
feel
the
pain well enough. However,
the
lack
of pain never means that the
coronaries are
milder.
Thus,
in
diabetics
and
the
elderly,
watch out for breathlessness, inability
to
lie flat,
cough
with
pinkish,
frothy
phlegm, cold
sweats,
pallor,
etc.
Rush them
to
hospital!
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