WHO SHOULD ANSWER THE QUESTIONS LISTED BELOW:

The person who answers the questions listed below should have
experience in emergency room medicine. The emergency room experience
should include treating people, especially older people, who have been
involved in car accidents. The emergency room experience should also
include treating people, especially older people, who have complained
about having chest pain.

QUESTIONS TO BE ANSWERED:

These questions are concerning a car accident I had many years ago.

I understand, with the limited description provided below, it is not
possible to be certain about your answers. I am interested in what you
feel is most probable, or most likely. Based on the description
provided below, and your experience, please answer the following
questions:
  1. What is the probable reason, or reasons, the passenger placed his
hand over his heart?
  2. Is it probable the stress that occurred during the accident may
have had any long-term impact on the passenger?
  3. How confident do you feel in your answers to questions 1. and 2.?
  4. What background do you have that makes you feel you have the
experience necessary to answer the questions listed above?

DESCRIPTION OF THE CAR ACCIDENT:

The two-car accident occurred in rural Greece around 8am. I was making
a left-hand turn and hit the rear part (rear driver?s side quarter
panel) of the oncoming car on the driver?s side. The accident happened
on a two-lane road with the other car coming in the opposite
direction.

From the time I hit the other car, which was a cab, till the cab
braked suddenly to a stop was, at most, ten (10) seconds. The cab
driver did not appear to lose control of the cab nor did he hit
anything as he braked the cab suddenly to a stop on the side of the
road. What stopped the cab was not the impact of the two cars but from
the cab driver braking suddenly.

Even though both cars required repairs it was not a major accident.
Both cars were able to be driven away. Neither car had to be towed.

Right after the accident I immediately checked on the cab driver and
his passenger, who was also sitting in the front set of the cab with
the cab driver. The passenger was a man who looked to be in his
sixties (60?s). He was of average build for a man of his age. He was
not obese but he was not thin. Both had no obvious physical injuries,
there was no blood, no broken bones, etc. The passenger had a look of
shock or surprise on his face.

I feel confident the cab driver and the passenger were not wearing
their seat belts.

My next memory is seeing the passenger sitting on the side of the road
with his right hand over his heart. I believe he was clutching at this
his heart, but I am not sure. A Greek soldier was bending over him. It
appeared the soldier was speaking to him. This memory was only a
?snapshot?. I do not know how long the passenger was sitting on the
side of the rode, and if he kept his hand up to his heart, clutching
his heart or not.

I did not observe the passenger closely. I do not know if he was in
discomfort, short of breath, sweating, dizzy, or displayed any other
sign of distress. I do not know anything about the passenger?s medical
history. If the passenger was in discomfort he could have easily
communicated this to the soldier. The soldier would not have had any
problem summoning aid.

The police were not called to the scene. An ambulance was not called
to the scene. But I do not think it is unusual in rural Greece for the
police or an ambulance not to be called, except in the most serious of
accidents.

I was on the scene of the accident, able to observe most everything,
for at least fifteen (15) minutes, maybe as long as thirty (30)
minutes. After this time everyone went their separate ways.

I believe the cab driver and the passenger left the scene of the
accident in their cab.

Above, I have stated what I remember about the accident. But what I do
not remember is also important. Following I list two things that if
they had happened, I believe, I would have certainly remembered them.

If the passenger had told any of the soldiers that were around him
that he was in discomfort I believe the soldiers would have summoned
aid. If aid had been rendered to the passenger there would probably
have been a certain amount of activity around the passenger. I do not
remember any type of unusual activity around the passenger. I would
have been able to observe this activity if it had happened.

I also do not remember the passenger being carried to a vehicle (no
ambulance was called to the scene) to be taken away for medical care.
I believe I would have remembered this if it had happened.

I welcome any questions from you that you need answered to help clarify anything.

********** END **********

Okay, I'll take a stab at this one,
1. The reason he grabbed his chest is almost impossible to know
without details of his symptoms (i.e. a quick medical interview), an
exam, maybe some imaging studies or lab work.  This is the reason
people go to emergency rooms.  Here's a list off the top of my head:
- Anxiety (likely)
- Direct trauma to chest (likely) - including sternum/rib fracture,
bruising, laceration, etc.
- angina or MI (heart attack)
- asthma
- reflux/GERD
- 'bad' trauma things - ruptured aorta (patient is likely dead
quickly), dissecting aorta, pneumothorax (collapsed lung), hemothorax,
hemopericardium (blood around heart) with tamponade (blood pushing on
heart from outside, preventing it from beating correctly)
- abdominal trauma
Here's a few more (though first list doesn't include trauma causes...)
http://www.guideline.gov/summary/summary.aspx?doc_id=6534
Of course, this isn't an exaustive list.  I'll let someone who's
getting paid type that out :-)

2. I don't know that I'd say probable, but definitely possible. 
Post-traumatic stress disorder (PTSD) can be significant, and affect
anyone who has a 'near-death' experience (i.e. they were, at some
moment, truly afraid for their lives).  See here for more:
http://www.ncptsd.va.gov/
Also, I guess if the patient had a heart attack (which, by definition,
means there was death of heart tissue) that would be a permanent
change.  While the fact that the passenger seemed okay is reassuring,
some old people are more frail than others, and it's possible that
there was some traumatic injury from the accident, although it didn't
sound that bad from your description.

3. I'm just speculating.  Unfortunately, I can't rule in or rule out
anything based just on the recollection of the event. (Okay, I
lied...if he lived through the event without immediate medical care,
the 'bad trauma' things above are pretty unlikely). But this is why
physicians like to see, talk to, and evaluate a patient before making
a diagnosis.

4. I'm an M.D. 

Hope this helped a little.
js

Hi Stan,
I know, you don't really want any amateur comments, but sometimes they
incite people with better knowledge to take the trouble to comment. 
Crabcakes-ga, the G-A Researcher who most often answers medical
questions seems to be on vacation, but maybe she will return.

My analysis of the situation:
The accident was quite minor and occurred without anticipation by the
taxi driver and his passenger  - they didn't see it coming -  since
you clipped the taxi after they could have thought they had passed
you.  They could hardly have suffered physical injury from the fender
denting, since the driver could maintain control, and the taxi could
later drive away, and because the blow to the rear of the taxi did no
more than jolt it.

Later the passenger was sitting down, although apparently of normal build.
Shock?  Delayed shock?  Most likely, feeling weak-kneed, heart racing
or abnormally slow.  Either are considered "palpitation".

# A fluttering of the heart or abnormal rate or rhythm of the heart
experienced by the person himself.
www.health.qld.gov.au/qldheartkids/glossarylp.asp
# A palpitation is an awareness of the beating of the heart, whether
it is too slow, too fast, or at its normal frequency; brought on by
overexertion, alcohol, disease or drugs, or as a symptom of panic
disorder.
en.wikipedia.org/wiki/Palpitation

Wikipedia may not be a medic's choice as a reference, but the more
generous description is useful.  Certainly awareness of an unusual
heart rhythm could be a reason to put one's hand on it.
Since I am assuming no trauma in the medical sense, the palpitation  -
for whatever reason -  and shock would pass with the recognition that
nothing serious had happened.
An older man in rural Greece would probably not be medically savvy,
thinking that he might have had a heart attack if the symptoms soon
disappeared.  Many people suffer minor heart attacks and "brush them
off".
I won't rule one out  - the doctor said that my 90 year-old mother
probably had several, but none debilitating.  Maybe the man had
experienced palpitation before sometime, and from experience knew that
it would pass.
And he probably would have brushed off suggestions for medical help,
being unaware of the possibility of internal injuries:  "Nothing
broken, no blood, what for?"

Remember that in the previous comment, after Dr. Shaw listed all the
worst case possibilities, at the end he said that he thought the "bad
trauma" things were pretty unlikely.  I reckon that many of us have
injured someone with words more than you injured that man  - if you
did.

Myoarin

Dr ?js? (jshaw-ga),

Thank you very much for your response. It sounds like you definitely
know what you are talking about.

If possible I would appreciate some more detail. I would be willing to
move your response from a Comment to an Answer (payment of $100) if I
can get the additional detail (through your next posting or postings)
I?m requesting.

Again, I understand there is no way that you can be certain about your
answers to my questions.

In your response to my first (1. ) question you listed several things
that you felt maybe the cause(s) why the ?passenger? grabbed his
chest. Of these possible causes you only placed ?likely? out to the
side of two (?Anxiety? and ?Direct Trauma?) of them. Are you
suggesting that the most probable cause(s) were ?Anxiety? and ?Direct
Trauma? and that the other causes you listed are less likely or
unlikely causes?

In your response to my second (2. ) question you list several things
that you felt might have a long-lasting or a permanent impact on the
?passenger?. One of the things listed was a heart attack. Based upon
the severity of the accident (the accident was more than a
fender-bender, but not much more), the stress related to the accident,
my description of the ?passenger?, (the rest of the details in the
description of the accident I provided), etc., do you think it is
likely the ?passenger? had a heart attack?

The last thing you mention in your response to my second (2. )
question was concerning the ?passenger? receiving a traumatic injury.
You mention this as a possibility, but then seem to discount it. You
also seem to go further in your response to my third (3. ) question by
saying you felt it was ?pretty unlikely? the passenger received
injuries which would have amounted to ?bad trauma?. Do I understand
you correctly when I say you do not believe the ?passenger? incurred
serious traumatic injury during the accident?

I appreciate your opinion (understanding that you are only
speculating) concerning this issue. I am very interesting in hearing
any other insights you could provide.

Thanks,

Myoarin (myoarin-ga),

Thank you very much for your comments. I appreciate you taking the
time to look in to my question. I welcome comments from anyone willing
to evaluate my question and give a thoughtful response.

Again, thank you,