Chest pain is one of the serious most symptoms that drives one to medical attention. The notion that it may be heart attack often causes panic. On the other hand, neglecting it for ‘not so serious’, ‘gas’ or ‘ingestion’ leads to serious complications because of late presentation. One needs to have some knowledge of chest pain of cardiac origin to recognize it early and, at the same time, to avoid unnecessary apprehension.
What are the patterns of cardiac pain one can develop?
One can have chest pain acutely, suddenly or it may be chronic, long standing.
What are the causes sudden chest pain?
Other than heart attack itself, it may be due to other rare cardiac problems like aortic dissection, pericarditis, pulmonary embolism etc. It may also be due to non cardiac reasons like esophagitis, pancreatitis, gastritis, pneumothorax, pneumonia, costochondritis etc.
What are the causes of long standing chest pain?
Chronic, coronary, artery disease is the most common and most serious cause of chest pain. Apart from this, aortic stenosis, hypertrophic cardiomyopathy, Pulmonary Hypertension , pericarditis etc. Are among other cardiac causes of chest pain. Peptic ulcer disease, chronic pancreatitis or musculoskeletal pain are among non-cardiac causes.
How one can recognize cardiac pain?
Cardiac pain usually most severe in mid chest, it may radiate to inner side of both arms, throat, neck, abdomen and back, but never below umbilicus and above chin. Most importantly, the character is compressive or crushing or sense of heaviness rather than dull aching or pricking type. Another important characteristic is its relationship to exertion and stressed, it comes on exercise and goes off taking rest. Usually, it lasts for few minutes, but never for fraction of seconds.
What does it mean to have cardiac pain?
It means there may be blockage in the coronary arteries, which feeds heart and keep it functioning. If not addressed timely one may develop heart attack or even sudden death.
Who are at risk?
Those who smoke or have diabetics , high blood pressure, cholesterol abnormality, family history of coronary artery disease are at high risk of coronary blockade. Other risk factors include obesity, sedentary lifestyle and elderly age.
What to do?
Get checked by a physician. Usually classical history is often sufficient to make a diagnosis even when ECG, echo and other essential investigations are normal.
How to confirm?
Stress exercise (TMT) or imaging (stress echo/ nuclear scan) may give indirect evidence. But coronary angiography gives not only confirmation but also guide further treatment plan whether repair ( angioplasty or bypass) is required or not.
Does everyone need repair?
A vast majority who have long standing angina do not require repair. Only medications may be sufficient. However, in acute setting of heart attack, most people are benefitted from angioplasty.
Dr. Rathindranath Karmakar
Consultant, Interventional Cardiology
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