Am I the Heart Attack?

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A few weeks ago, I woke up at 3 a.m. with excruciating chest, arm, neck, and back pain.  It was the kind of pain that resembled everything I’d ever read or heard about the pain which precedes a heart attack. I don’t know what the typical response is for a man who senses that he’s experiencing a cardiac emergency, but my response was probably a textbook example of what not to do: I stayed in bed and let my thoughts run wild.

This can’t be a heart attack. I’m not breaking out in a cold sweat. I’m a healthy and well-controlled type 1 diabetic. I’m not short of breath. I exercised last night and felt fine. I had carrots and celery for my nighttime snack last night. I can’t afford to have a heart attack. What does a room in the cardiac ICU cost, ten thousand dollars a day? What if I die? What will my wife and son do without me? Why did I neglect my diabetes in my 20s? I ate too much pizza in college.  God, I really can’t miss work today. I wonder if I can get to the emergency room and be out in time to get to work.

After about 30 minutes of panicking and waiting for things to get better, I vomited. I remembered that my father-in-law had experienced the same symptoms when he’d had a heart attack two years ago – chest pains then vomiting.

I woke my wife, Theresa. “I need to get to the hospital,” I said.

We dressed quickly and as we were walking out the front door, my compulsive need to know my blood glucose level at all times (which apparently persists even under threat of cardiac arrest) forced me to test.  It was 180 mg/dl, quite high for the middle of the night.

Before we were out of our neighborhood, my chest pain had worsened.  So had my state of mind. I was trying to convince Theresa to drive faster, but she was thinking clearly and decided we should stop at the firehouse up the road and hitch a ride in an ambulance. She figured it would be a good idea to be hooked up to an EKG sooner rather than later. We called 9-1-1 and when we pulled up to the firehouse, the gate attendant yelled out to us, “Are you the heart attack?”

“Am I the heart attack?” I asked myself.

As is typical for paramedics, the men who met me were professional, fast, and smart. They hooked me up to the EKG and took my vital signs. The EKG indicated a normal heart rhythm. My blood pressure and heart rate were normal too. The paramedics asked a series of questions and decided that it was still best to get me to the hospital. They sprayed nitroglycerin, a drug that lowers blood pressure and alleviates chest pain, under my tongue, loaded me into the ambulance, and pulled onto the highway.  Theresa wasn’t allowed to ride with me, so she followed us to the hospital.

A few minutes into the ambulance ride, I felt nauseated and threw up again.  To calm my nerves, the paramedic named Kevin explained the EKG readings to me. Kevin talked about sinus rhythms, p-waves, t-waves, QT intervals, PR intervals, and ST Segments, all of the things that indicate whether your heart is beating to the rhythm of the right drum.  He joked about how the EKG patterns on TV shows look like they are heart rhythms of amphibians, not humans.

Since I was incredibly anxious, I asked Kevin to test my blood glucose, which always skyrockets under stress.  Blood glucose might not have been on Kevin’s top ten list of things to monitor, but I knew that high blood sugar could lead to high ketones, and the last thing I wanted was to have a heart attack and diabetic ketoacidosis at the same time.  My blood sugar was up to 280.  I bolused 5 units of Humalog.

Although by the time I arrived at the hospital my chest pains had subsided, that didn’t lessen anyone’s sense of urgency. In fact, arriving at the emergency room with a suspected heart attack was like having front row seats above the home dugout at Yankees stadium.   I moved right to the front of the line ahead of the broken legs, stab wounds, neck injuries, 3rd degree burns, 103 degree fevers, dog-maulings, and baby deliveries. No waiting, VIP treatment.

One doctor and three nurses peppered me with questions, poked me with needles, and x-rayed my chest. My blood pressure had dropped to 70 over 20 because of the nitroglycerin, so I lay flat on my back while they pumped fluids into my arm.  After 30 minutes my blood pressure normalized, and within the hour the doctor came to me with some initial test results. He said my chest x-ray looked good, my EKG seemed normal, and the first cardiac enzyme test was negative. But, as 39-year-old type 1 diabetic, he said I was at a much higher risk for cardiac events. The initial tests were a good sign, but there could be underlying problems that these tests might not detect. He felt the best course of action was to hospitalize me for a few days so I could undergo a complete cardiac workup. The choice to stay or go was up to me.  I didn’t want to walk out of the hospital, collapse and die in the parking lot, and then have the doctor say, “I told him he needed more tests, but he just wanted to go to work.”   So I opted for a sleepover at the hospital.

The Cardiac ICU wasn’t too busy that week.  My room had two beds, but I was the only patient.  It was a plain-Jane room: a bed, a moveable tabletop, and a tiny little TV with 65 channels, static and fuzz at no extra charge.  My nurse, Jeff, explained that I needed to have three more cardiac enzyme tests over the next 24 hours, and after that, if things looked okay, I would take a stress ECG. He said all of the tests would give a fairly definitive report of the state of my heart.

I spent the day in the hospital, hooked up to a half dozen wires and at the mercy of the lab tech who came every 6 hours to draw blood. I tried to watch TV, but nothing really interested me until Oprah’s infamous diabetes show came on. That show made me thankful that my doctor’s name was Browning, and not Oz.

I had a lot of time to think about diabetes and my health. In so many ways, I’m lucky to be alive. I spent many years in denial about diabetes, and made bad choices during my 20s. It’s easy to make bad choices about diabetes because the consequences usually don’t hit you immediately.  But when you’re sitting in a Cardiac Unit in the hospital, every bad choice you’ve ever made, every skipped shot of insulin, every Krispy Kreme doughnut, and every bag of Doritos come back to haunt you.


You would think that the hospital would be the one place on earth where you wouldn’t have to explain your diabetic needs, but that was not the case.  This is the most important thing that a diabetic needs to understand when entering a hospital.  The people working in a hospital have a theoretical, textbook understanding of diabetes, but they may not have a practical sense of your diabetic needs.  If you are a patient with diabetes, it is your job to make sure that the medical professionals know what they’re doing when they’re making decisions that will affect blood glucose, food intake, and insulin levels.

For instance, the food service people forgot feed me, and I had to remind them that I was a type 1 diabetic on an insulin pump and that I would create quite a scene if my blood sugar dropped much below 50.   The hospital’s diabetic meals – based on an ADA approved diet, had 60 grams of carbohydrate per meal.  In a typical day, I rarely consume more than 40 grams of carbohydrate.  This forced me to make a choice between not eating very much or making a huge adjustment in my insulin intake.  I chose to just eat the protein portions of the meals.

Late in the evening I was finally able to speak to my doctor. He told me that the first three enzyme tests were all normal, and that I was scheduled to do a “treadmill test” first thing in the morning.

First thing in the morning is hospital-speak for 10 a.m., and at 7:30 a nurse told me I wasn’t allowed to eat until I’d had my stress-test.  I reminded them again that insulin waits for no man, and that they needed to get me some breakfast. They called the cardiologist and got permission for me to eat what was easily the worst meal of my hospital stay.  For reasons that are still unclear, they chose to serve me a “Low Cholesterol” breakfast. Eggs, Malt-o-Meal, two pieces of toast with sugar-free jelly, eight ounces of apple juice, and a carton of milk. Over 70 grams of carbs!

After the stress test, the cardiologist said that there was no indication anything was wrong with my heart. He said I had “a pretty good pump under my sternum.” He warned me that heart disease is the leading cause of death for people with diabetes, and that I needed to take my heart health seriously. He speculated that my chest pain might have been caused by GERD (Gastro-Esophogeal Reflux Disease, a fancy name for indigestion), since the nerves in the esophagus are closely linked to the nerves near the heart. GERD is a frequent cause of severe chest pain, he said, but since the main goal of my stay at the hospital had been to rule out heart disease, he wasn’t going to attempt to make a diagnosis. He did mention that since the esophagus has a smooth muscle lining, it’s common for nitroglycerin to calm the painful symptoms of GERD.

I’m not happy that I spent two days in the hospital due to indigestion with a funny name, and I’m not entirely convinced that I had GERD. My family doctor had recently taken me off some anxiety medication, and when I looked online for withdrawal symptoms, I found that many people reported suffering chest pain.

The good news is that I haven’t had any repeat of the symptoms.  Part of me wishes they’d found an alien growing inside of me, or something that would have warranted a twenty thousand dollar hospital stay. The rest of me is relieved to be okay.  And while overall, the experience was frightening, I did enjoy seeing my heart at work during the stress test, like a fist expanding and contracting, over and over again, the little valves opening and closing like taxi doors. Forty to 160 times per minute.  All day.  Every day.  For a lifetime.

Jim is a type 1 diabetic living a happy and healthy life with his wife, son, and dogs in Nevada City, California. Thanks to the love and support of friends and family and doctors, he’s successfully managing his condition and is working to help others do the same. Jim was diagnosed in 1977, and is currently pumping with a Paradigm 722. He’s been blogging since March 2009.

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Comments (5)

  1. Victor at

    Awesome article. Thank you very much.

  2. Debra at

    Thank you. Your article was a comfort at a difficult time.

  3. larry at

    And everyone else. I am currently laying in bed at noon time after having an episode just like what Jim has just described. Having read your article brought me to rears. I am a 63 year old male and tears don’t come easily. This event was relatively mild this morning. I stayed in my hotel room, alone, praying that it wouldn’t escalate to what I have experienced a half dozen times before. In each if those time, my wife took me to the ER, where I also was tested ad infinitum and then sent home. I’ve been searching for two years for anything similar to what I experience. Jim, you’re the first. So, Aug least I now know I’m not alone. My doc recently prescribed me Baclofen, a strong muscle relaxer. I took two this morning and squirmed in pain for about 15 minutes. Then a calm came over me. Until this, morphine was the only thing that worked. I was being suspected of being a junkie coming in for a quick fix. So, as directed by my cardiologist, I kept a log of these events in my phone to show that I had a history of events bringing me in. Maybe you do the same in c a second there is a next time. I don’t know if the Baclofen really worked or if this was just a milder episode. I was in the past, taking an antidepressant which I blamed and have stopped taking. Do, I was a little disappointed at the onset thisorning, but was pleased with the short duration. I don’t have advice, except to have the Baclofen on hand. I’m reaching out here in case others with same history if episodes read and I’d anyone who has gone through it has a solution for it. Jim, thanks again for having the strength to write. I have two questions. Did your bs stay elevated for quite a while after your episode and do you think your bs rose, to cause this, maybe because the insertion location of your pump was becoming inefficient? After two days in a location other than the stomach, my site get inefficient and my bs rises while I’m asleep, and continues to do so throughout he next day because there is no insulin on board, and I have to guess at how long I’ve been without insulin, to accommodate for it.

  4. Audrey Jennings at

    Thank you for your story. I am a newly diagnosed Type 1 with only two years of experience under my belt despite being 30. I have been experiencing random heart pain in conjunction with an exponential increase in A1c from 6.0 to 9.0. With that had come an increase in cholesterol levels that should require me to be on a statin. I am a good eater who doesn’t keep butter, eggs, or red meat in the house and I’m fairly young so the cholesterol is disconcerting. Thank you for bringing up that one has to be his or her own advocate in all medical situations. I have had to push back on an endocrinologist who didn’t want to put me on the statin because I might change my mind a decide to have children. She is incorrect. I have also had to be a master of my blood results and explain type 1 to the GPs I’ve had to see fit referrals. One more call from a nurse about how to maintain my blood sugar and I will scream. Thank you for sharing and for letting me vent. 🙂

  5. Larry Reinhard at

    The energy that I was filled with after reading Jim’s story and the hope that he might have found a solution are still high and hopeful.i will connect with Jim as I am learning more and more about blogging, Audry, I will keep reading this so we can learn together,the function,i thought of this site. I have never recorded the A1c fluctuations that you have, but I’m sensing that when you were diagnosed, your level was 9 and through constant monitoring it will stay down. I hope the heart pains subside as a result. The medical world is full of as I call them”instant geniuses”. Another reaso this is a good location,for sharing . It’s not as fast as I’d like,but neither are many events. A start is the best eye doc asked me, what was your last glucose test level, I said 241dl/mg. She said, “I can’t treat you”. This answered my question about how si many other diabetics are in such great ranges, they lie so they don’t have to hear those kinds of statements from doctors. My eyes look like, as my eye doc said, like I’ve never had diabetes. So walk daily out so and keep that plaque, cholesterol and A1c moving with you. Denial is a symptom of this condition,and movement can eliminate the episodes for practicing denial. If I didn’t say, I am 62 type 1 at 11 years old, on a pump for about 20 years sober for 13. Denial, drinking won’t hurt me just because of diabetes. 2 episodes of in the elevator with 14 FL/mg. Liver paying attention to my alcohol not my bs, and I was full of that back then, I digress. I think I can be a little help here but I tend to not give advise,just history.

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