Stress of war takes its toll: More than bomb blasts or gunfire, chest pains plague those downrange
Stars and Stripes March 18, 2008
LANDSTUHL, Germany — After five years of the war in Iraq, you might think that most troops and civilians medically evacuated from the war are treated for blast, gunshot or other combat injuries.
You’d be wrong.
Atop the list is chest pain.
Of the nearly 40,000 patients from Iraq treated at Landstuhl Regional Medical Center since the start of the war, only about 9,000 suffered battle injuries.
“If you look at the history of war, this is not unusual,” said Navy Capt. (Dr.) Miguel Cubano, surgeon and chief of the hospital’s Deployed Warrior Medical Management Center. “There have always been more non-battle injuries and actual accidental deaths in many of the conflicts.”
Even at peak combat times in Iraq such as the battles in Fallujah, chest pain remained the most common ailment, Cubano said.
“The majority of them, thank God, pan out not to be of cardiac origin,” he said.
Early in the war, Landstuhl treated many reservists for chest pain. At that time, Army Col. (Dr.) Randolph Modlin, cardiologist and the hospital’s chief of medicine, called the conditions in Iraq “a natural stress test.”
“When you put a middle-aged man in 130-degree heat, give him 40 pounds of gear and start shooting at him, all of the sudden that can bring out a lot of heart disease that may not have been appreciated before that time,” he said.
The current population seen at the hospital for chest pain is senior officers and NCOs who are in the age group who would have early heart disease, Modlin said. About 17 percent of the patients Landstuhl evaluates for chest pain are contractors from downrange usually in their 50s, he said. Overall, the patterns among Landstuhl’s chest pain population are not different from a civilian setting, doctors said.
In 2007, 43 percent of downrange patients treated at Landstuhl for chest pain were returned to duty. That return to duty percentage for chest pain patients has remained consistent throughout the war, Modlin said.
Chest pain can run the gamut from heart attacks and acute coronary syndromes to atypical chest pains — a pain that’s probably not from the heart, Modlin said.
Landstuhl has three to four patients a week from downrange admitted directly to its intensive care unit with acute heart attacks or on the verge of having heart attacks. About 10 to 15 patients a week arrive at the hospital with chest pains that can be evaluated in an outpatient setting.
Factors that bring on chest pain include stress, dehydration, lack of sleep, tobacco use and carrying heavy gear — just to name a few.
“Certainly carrying around all that gear, as well as the body armor, causes a lot of musculoskeletal symptoms that can often be confusing,” Modlin said. “There are a lot of reasons people develop chest pain. ... Stress has a lot of funny ways of coming out, and that’s also a big cause for the patients we see with chest pain.”
Last year, Landstuhl performed 120 angioplasty procedures, and the vast majority were done on patients from Iraq and Afghanistan, Modlin said. Compared to the military active-duty population, civilian contractors have a larger number who require some kind of intervention for chest pain, Cubano said.
“This is one of those diagnoses that if we establish the cause for it and we find it’s not a critical issue, we can send that guy back to work,” Modlin said. “That I think is a major benefit of sending them up here. By … ruling out coronary disease, we can return that soldier to his unit downrange and actually give that commander his soldier back.”