Did he really have a heart attack?

The 67-year-old man fell heavily in the plastic chair at the Alta Mountain resort in Utah. It was his third day of skiing in the Rockies, but his first in Alta. He’d been excited to try these new slopes, but his run that morning was brutal. It was a clear, cold day, and the jagged mountain ridges stood out sharply against the clear blue sky, so different from the east slopes where he lived and usually skied. About halfway up a moderate slope on his first run that morning, the man began to feel bad, as if he was coming down with something. He rested for a few minutes and when that didn’t help, he went back to the lodge. The journey down was miserable. He felt a strange exhaustion and had to stop every few minutes, as if running up the mountain instead of skiing down. It was so bad that at one point he feared that he would have to be caught by the ski patrol. But he made it. Finally.

Entering the warmth of the lodge, he was greeted by the usual smell of coffee and the cinnamon-like charm of freshly baked pastries, but he wasn’t hungry. As he sat by the fire, he tried to figure out what was going on. He was no longer out of breath and that was a relief. But now he had a strange pain in his chest, a few inches below his right collarbone, as if he were straining a muscle. And he was sweating like crazy. He felt the coolness of the sodden shirt against his chest. He could see the dark damp seeping through his turtleneck. A door opened and the cold air cooled the sweat on his face. He just sat there and couldn’t do anything more. It took almost an hour for him to start to feel better; the pain in his chest was still there, but the crazy sweating had stopped. And he felt well enough to return to those beautiful slopes.

But first he had to buy a new shirt; the one he was wearing was soaked and he would be cold on the mountain. Finally dry and rested, he grabbed his skis and headed for the lift. On the way he saw the first aid building. He felt okay now, but was worried: was he good enough to ski? A young woman was working behind the counter. He described the strange and sudden fatigue he had on the slopes and the soaking sweat and chest pain he had in the lodge.

A young man appeared out of nowhere. “I want you to come with me,” he said, introducing himself as the doctor on duty. The man needed an EKG, the doctor told him, and led him to an exam table. He placed the sticky tabs on the man’s chest, arms and legs. “You’re having a heart attack,” he explained gravely as the heartbeats moved across the screen. “No, I’m not,” the man replied promptly. He’d never had a heart attack, but he knew how they must feel. He had no chest pressure, just this pain. And it wasn’t even on the left side, where heart attack pain is most common. The doctor insisted: the EKG clearly indicated a severe heart attack. The man resisted. “Call my son,” he said. “He’s a doctor. He’ll tell you I’m not having a heart attack.”

This post Did he really have a heart attack?

was original published at “https://www.nytimes.com/2022/02/03/magazine/takotsubo-syndrome-diagnosis.html”