A middle-aged male, clutching his chest with an agonized expression on his face: this represents an icon of a heart attack. As most of us know, chest pain is a major symptom of a heart attack, particularly in men. And doctors stress that there is no time for second guessing or denial when that or any other symptom presents itself. It’s better to be wrong than sorry.
Nevertheless, it should be remembered that
• chest pain is not the only sign of a heart attack;
• it is not even the most common sign in females and
• there are many possible reasons for chest pain, not all of which are signs of a heart attack or even heart-related.
It’s helpful to understand the nature of heart-related chest pain and why it happens.
ANGINA AND ISCHEMIA: Angina is the medical term for heart-related chest pain. It typically occurs because of inadequate flow to and through the blood vessels of the heart.
The heart is a muscle, and when it is not receiving the blood and oxygen it needs to do its work, it lets you know through pain, pressure, squeezing or other types of discomfort. Known as ischemia, this lack of blood flow typically occurs during exertion or as a result of emotional stress, extreme heat or cold, a heavy meal, excessive alcohol consumption or cigarette smoking.
Signs of Heart Disease
Coronary heart disease patients with blood vessels that have become narrowed or clogged with fatty deposits experience frequent attacks of angina. These are not heart attacks, and they can be relieved through rest or taking prescribed medication such as nitroglycerin. They are signs of heart disease, however; some part of the heart is not receiving the oxygen it needs. And the condition requires monitoring and treatment by a doctor.
There are several types of angina. Stable angina has a predictable pattern and can be controlled. You climb a flight of stairs after dinner or rush to cross the street before the light changes, and you experience chest pain. Stop and rest for a few minutes or take nitroglycerin, and the pain goes away.
Unstable angina is less predictable and more worrisome. The severity, frequency or duration of the pain increases and may even occur at rest.
Variant angina usually occurs at rest, sometimes during the night or early morning hours.
Any type of angina needs treatment. The first step involves changes in lifestyle: weight loss, regular exercise, a better diet, avoidance of cigarette smoke. Medications may be prescribed to lower blood pressure and cholesterol and relieve the bouts of angina. And some patients eventually require heart surgery or angioplasty and stenting. But the angina itself is not yet an emergency.
MYOCARDIAL INFARCTION: A heart attack, known medically as a myocardial infarction, occurs for essentially the same reason–inadequate blood flow to the heart. But the situation is much more immediately catastrophic.
The surface covering of the plaque ruptures and a blood clot forms on it, completely or partially blocking blood flow. This blockage stops or significantly slows blood flow to a certain area of the heart muscle, causing immediate danger.
Time is muscle, cardiologists say. If the blockage is not cleared and blood flow restored, that part of the heart will become damaged or destroyed, resulting in death or long-term problems such as heart failure.
The pain or discomfort suffered during a heart attack is ischemic and similar to that of angina. It is not necessarily more severe, but it is more persistent and not relieved by rest or nitroglycerin.
As with angina, the pain varies with the individual and is often hard to describe. Most patients describe it as pressure, squeezing, burning or tightness that starts behind the breast bone and may radiate to the arms, shoulders, neck, jaw, throat or back.
For women, the discomfort is more likely to be felt in the neck, jaw, throat or back. Older persons and those with diabetes may report shortness of breath as the major symptom. Other symptoms include nausea, fatigue, sweating, light-headedness, weakness and confusion.
Ischemic pain, whether angina or a heart attack, tends to come on gradually and get worse over time. And the pain is usually felt throughout the chest rather than in one specific spot.
OTHER CAUSES OF CHEST PAIN: There are many other causes of chest pain. The pain may be either short-lived or persistent but is usually unrelated to exertion or stress.
Weight lifting or any strenuous activity that uses the chest muscles can cause soreness and pain that is likely to be longer lasting than ischemic pain. Pressing on one area can pinpoint the pain and make it worse. Trauma, including recent surgery, arthritis, fibromyalgia and shingles can also be the source of chest pain.
The esophagus, a food tube leading from the mouth to the stomach, is served by many of the same nerves that serve the heart. Spasms of the esophagus, gastroesophageal reflux (also known as heartburn) and esophagitis (inflammation of the esophagus) are often mistaken for angina. On the other hand, heart attack patients have been known to mistakenly dismiss ischemic chest pain as heartburn or indigestion.
Lung problems such as pleurisy, an inflammation or irritation of the lining of the lungs, can cause a sharp pain when you breathe in, cough or sneeze. Pneumonia can cause pleuritic or other types of chest pain–often a deep chest ache plus fever, chills, coughs and coughing up sputum.
Other serious lung problems causing chest pain include pneumothorax (a collapsed lung) and pulmonary embolism (a clot in the blood vessels of the lungs).
A panic attack, which often lasts 10 minutes or longer, has symptoms strikingly similar to those of a heart attack: a pounding heart, chest pain, difficulty breathing, sweating, nausea and a feeling that you are going to die. Depression, anxiety and other psychiatric disorders can likewise produce troubling physical symptoms.
If symptoms such as these take you to the emergency room, there is no need to be embarrassed. As ER doctors put it: better embarrassed than dead.
Whatever the cause, unexplained chest pain is a serious matter that requires prompt evaluation. If it’s a heart attack, there is no time to sit and wonder why.
REFERENCES:
“Angina,” Speak from the Heart eHealth Navigator, October 15, 2012.
Julian M. Aroesty, M.D., et al, “Patient information: chest pain (beyond the basics),” UpToDate, last updated February 4, 2014.
Stephen Bosner, et al, “Chest pain in primary care: is the localization of pain diagnostically helpful in the critical evaluation of patients?” BMC Family Practice, 2013;14(154).
“Chest pain,” MedlinePlus, National Library of Medicine, updated by David C. Dugdale, III, M.D., June 22, 2012.
Anne Harding, “Chest pain symptoms not enough for AMI diagnosis in women,” Reuters Health, December 2, 2013.
Fran Lowry, “Office and outpatient visits for angina decline,” Heartwire, January 16, 2014.
Mayo Clinic Staff, “Chest pain,” MayoClinic.com, December 1, 2011.
National Heart, Lung, and Blood Institute, “What are the signs and symptoms of angina?”NIH June 1, 2011.
“What’s causing my chest pain?” WebMD Medical Reference reviewed by Andrew Seibert, M.D., August 13, 2012.
05/20/2014
For more information, sample newsletters or to get on our mailing list contact:
Community Relations
West River Regional Medical Center
1000 Highway 12
Hettinger, ND 58639-753