O.W., age 47, was sitting watching television when he suddenly felt a pain in the center of his chest. The pain felt like nothing he had ever experienced before. The entire lower two-thirds of his breastbone and part of his left chest felt as if someone was crushing him in a vice. He started to feel weak and afraid, and he loosened his collar to relieve the feeling of strangulation. He called his wife for some antacid for what he assumed must be terrible indigestion due to the high-fat meal he had eaten 30 minutes earlier. Two antacid tablets did not relieve the pain and he started
to pace restlessly around the room. He soon became dizzy, felt faint and was forced to lie down. The pain was not relieved by lying flat, so his wife propped him up and started rubbing his back. About 7–10 minutes went by and the pain was becoming worse; he felt as if he was going to die. Though a sense of panic was beginning to set in, he did not want to alarm his wife. His entire life seemed to float before him. He was determined to sit up and to walk to see if it would ease the pain. He moved across the room. The dizziness was less than before, but the pain was of the same intensity. Both arms, from the shoulders to below the elbows, were now aching as if he carried a 50-pound weight in each hand. There was no pain in his back. He tried to analyze what could be the reason for this pain. He had not done any physical work in the past month. It could easily be stomach upset because there was some discomfort at the lower end of his breastbone and stomach (epigastric area). He had been under pressure at work for the last month. His job was on the line and he was determined to show his colleagues and boss that he could cope. He had faced similar stressful situations before. Suddenly, as he was wondering about the past, the pain became excruciating, constricting his chest. He could no longer hide his fear. His wife noticed his face had become pale. She dashed for the phone and called an ambulance, which came 20 minutes later. The wait was agonizing as his breathing and the strangling sensation worsened. He had no nitroglycerin in the house because he was not known to have coronary heart disease. As soon as the ambulance arrived an oxygen mask was applied and he was rushed to the emergency room of the nearest hospital. A diagnosis of acute myocardial infarction was made and he was admitted to the CCU of the hospital. He made a reasonable recovery and was discharged on the 10th hospital day. He did have mild heart failure during the first two days in the hospital but this cleared quickly. A few days after his attack, he was placed on a beta-blocker, propranolol, and a drug to try to prevent blood clotting, sulfinpyrazone. He discontinued his two-pack-a-day smoking habit. His cholesterol was 1.3 mmol (280 mg), which is moderately elevated. He was not overweight but he was placed on a diet with low cholesterol, low saturated fat, and moderate salt restriction. He was placed on an exercise program. He had liked jogging in the past, and three months after his heart attack he was able to jog one to three miles daily.

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