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IS CHEST PAIN AN ATTACK? HARD TO TELL

Tom Mueller felt as if a 100-pound barbell were wedged against his chest.

"I thought it was gas, " the 50-year-old Simi Valley, Calif., salesman said. "I thought if I could just belch, I'd be OK."But he was having a heart attack. It killed about 6 percent of his heart muscle and left him permanently at risk: His life could end in 50 minutes or 50 years.

What irks him is that he waited three hours after the pressure began before he headed to the emergency room.

"It was denial," he said. "If I'd accepted it immediately, I wouldn't have lost part of my heart."

Clogged arteries or too many burritos for lunch. Doctors say the symptoms of both - a pressure in the chest that radiates to the back and a shortness of breath - can be indistinguishable. If they can't tell the difference how can you and I?

We can't. That's the problem.

If everyone who felt a twinge in the chest rushed to an emergency room, doctors would spend most of their time dealing with medical false alarms. But ignore the pain and you could end up, like Muel-ler, with a permanently damaged hear. Or you could end up like Suzanne Brockman's uncle.

"He stayed away from the hospital for two days because he said he was just having indigestion," said Brockman, marketing director at Community Memorial Hospital in Ventura, Calif. "He died of a massive coronary."

Coronary disease remains the nation's No. 1 killer, claiming 926,161 people in 1991, according to the American Heart Association.

But doctors react warily to the notion that every pain below the neck and above the waist is a signal to make out the will. They said people who know whether they have heightened risk of heart problems and understand the symptoms will realize when it's time to react.

They are: Men 45 and older. Women 50 and older. Smokers. Diabetics. People who have high cholesterol levels, high blood pressure or relatives with heart problems.

If you fit any of those categories and feel recurring chest pain, it's time to see a doctor, said Dr. Martin Josephson, a cardiologist in Thousand Oaks, Calif.

If you're not in a high-risk group, it means the three Big Macs you gobbled down - not your heart - are probably to blame for the pressure in your chest.

"You can't draw a line and say that if you're under 40, you don't have it," said Dr. Christopher Loh, a Camarillo, Calif., cardiologist. "But if a woman is under 40, has no family history (of hear disease) and doesn't smoke, she's a very low risk."

The thing about chest pains and heart attacks is they're not always a match. More than 10 percent of people who suffer heart attacks feel an immense pressure on their chests, but no pain.

"The pressure was far more severe than gas," said Mueller, the Simi Valley man who had a heart attack four years ago. "It was like this extreme weight sitting on my chest."

Loh said the pressure or pain often starts in the chest and moves to the neck, back and left arm. The discomfort most typically comes after some form of physical exertion, lasts 10 to 15 minutes and is relieved by rest.

If the pain is accompanied by sweating, shortness of breath and heart palpitations, you should go to the emergency room, he said. Patients with chest pain take top priority there.

Loh said an appointment with a cardiologist is preferable if the symptoms are milder but are recurring.

The thing not to do is ignore the pain.

"There's a whole lot of signals, and they're all mixed. If you have any of them, see a doctor," said Dick Spencer, a 57-year-old Camarillo resident.

About six years ago, Spencer felt a dull but recurring pain that would spread from his chest to his back. He thought it was indigestion. Three months and a heart attack later, he was proven wrong.

For a Thousand Oaks woman in her 50s, who asked that her name not be used, the warning sign was a sharp pain that started at her breastbone and radiated.

"I just figured it was indigestion or stress," she said. While not signaling heart attack, the pain was a symptom that a blood clot was temporarily clogging an artery, causing a miniature stroke called a transient ischemic attack.

For too many people, denial is easier than admitting you're sick.

Mueller, who stands 6-foot-7 and weighs 250 pounds, was so into denial that he kept smoking cigarettes as he walked into the emergency room.

"I think it's a macho-man thing," he said. "It's hard to accept that you body's doing this to you."

Such pride is costly. New types of medication, called thrombolytic agents, can break up blood clots and minimize the damage. But such medicine should be administered within about 90 minutes from the onset of the pain or chest pressure.

Indigestion and heart attacks are at either end of a spectrum. There's a lot of middle ground.

Loh said a pressure or pain that starts in the chest can also be a symptom of other heart problems such as decreased blood flow called angina. Or it could be related to problems with the stomach, gall bladder or esophagus.

Martin Daly, a 55-year-old Camarillo banker, spent Christmas weekend in the hospital after suffering recurring sharp bursts of pain in his chest. Doctors have ruled out his heart and want to do more tests to pinpoint the problem.

The problem is his HMO has initially ruled against paying for the tests.

Insurance coverage of chest pain appears to be a gray area. Dr. John Hess, a Thousand Oaks cardiologist, said he's never heard of a patient who had trouble persuading an HMO to cover a trip to the emergency room because of chest pain, even if it turned out to be indigestion.

But representatives of Mutual of Omaha and Kaiser Permanente said such trips could be subjected to review.

Whatever your coverage, Camarillo cardiologist Loh urged people to to let it keep them from seeking medical help.

"You have to know that your life comes first," he said.

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ADDITIONAL INFORMATION

Your heart-disease risk increases if you:

- Smoke

- Have high blood pressure

- Are a man older than 45 or a woman older than 50

- Load up on high-cholesterol or fatty food

- Have diabetes

- Have a family history of heart disease

- Are overweight

- Are a couch potato

You could be having a heart attack if you experience:

- Uncomfortable pressure or pain in the middle of the chest that lasts more than a few moments, or disappears and returns.

- Pain that spreads to shoulders, neck or arms.

- A lightheaded feeling, fainting, sweating and nausea.

By Scripps Howard Service