July 26, 2010
Dr. John Maloof
Chest Pain. The words alone provoke fear. However, there are many possible causes of chest pain. Some causes are mildly inconvenient, while other causes are serious, even life-threatening. Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons or nerves.
Chest pain from a heart attack
The most serious cause of chest pain is a heart attack. A heart attack occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. Often, this blockage leads to an irregular heartbeat or rhythm that causes a severe decrease in the pumping function of the heart and may bring about sudden death. If the blockage is not treated within a few hours, the affected heart muscle will die and be replaced by scar tissue.
A heart attack is a life-threatening event. Everyone should know the warning signs of a heart attack and how to get emergency help. Many people suffer permanent damage to their hearts or die because they do not get help immediately.
Each year, more than a million persons in the U.S. have a heart attack and about half of them die. About one-half of those who die do so within 1 hour of the start of symptoms and before reaching the hospital.
Emergency personnel often can stop arrhythmias with emergency CPR, defibrillation and prompt advanced cardiac life support procedures. If care is sought soon enough, blood flow in the blocked artery can be restored in time to prevent permanent damage to the heart. Yet, most people do not seek medical care for two hours or more after symptoms begin. Many people wait 12 hours or longer.
If you think you are having a heart attack, call 911 immediately. The warning signs and symptoms of a heart attack can include:
- Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness or pain. Heart attack pain sometimes can feel like indigestion or heartburn.
- Discomfort in other areas of the upper body. Can include pain, discomfort or numbness in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
- Other symptoms. May include breaking out in a cold sweat, having nausea and vomiting, or feeling light-headed or dizzy.
Certain people are more at risk of having a heart attack than others, including those who
have high blood pressure or cholesterol levels; are obese; have a family history of heart disease; smoke; or are physically inactive.
Cardiac catheterization is used to detect and evaluate conditions of the heart. A very small catheter is inserted into a major artery (usually in the groin) and navigated through the aorta into the heart. Procedures are typically performed by interventional cardiologists, a sub-specialty within cardiology with special training in catheter-based diagnostic and interventional procedures.
Catheter-based intervention offers patients shorter hospital stays, reduced recovery time without the pain of a large incision, and minimal surgical scarring. The procedure also reduces the risks and recovery time found in traditional surgical approaches.
Coronary arteriography (X-ray photography of coronary arteries), angioplasty (using a balloon to open blocked or closed arteries) and stenting (inserting a tiny mesh tube that supports artery walls and keeps vessels open) all are performed in a cardiac catheterization lab.
Causes of non-heart related chest pain
- Gastroesophageal reflux disease is a common condition in the United States resulting from the exposure of the esophagus to acids normally found in the stomach. It can be painful and often mimics the pain individuals associate with a heart attack, such as severe pain in the mid-chest area. With appropriate diet changes and medications, it is a manageable disease. Often chest pain due to GERD can be relieved once treatment is started
- Costochondritis is also common. Costochondritis produces chest pain when moving, taking a deep breath, or when someone touches the chest. It results from an inflammation of the area that joins the ribs and the breastbone. This is a very painful condition that is the source of chest pain for many patients. With appropriate treatment, costochondritis will go away and you will be pain free eventually.
- Pleurisy is an inflammation of the thin lining that surrounds the lungs. Between the lining around the lungs, the pleura and the lung tissue itself, there is a small amount of fluid that helps the lungs move freely within this lining. Sometimes this lining becomes inflamed and produces severe pain when taking a deep breath. As with costochondritis, pleurisy can be treated successfully and your comfort restored with anti-inflammatory medications.
Chest Pain Center
Sometimes the source of chest discomfort may not be clear and you may be admitted to a Chest Pain Center for further observation and diagnostic tests. Your physician will discuss with you the outcomes of your diagnostic test(s). If there is a possibility your heart is the source of your chest pain, you may be admitted to the Medical Center. If the physician determines your chest pain is not heart-related, you may be discharged.
Key diagnostic tests are:
- Electrocardiogram (ECG or EKG). This is a graphic record of the electrical activity of the heart as it contracts and relaxes. The ECG can detect abnormal heartbeats, some areas of damage, inadequate blood flow and heart enlargement.
- Blood test. A blood test will be done routinely to check for enzymes or other substances that are released when cells begin to die. These are "markers" of the amount of damage to your heart.
- Nuclear scan. This test shows areas of the heart that lack blood flow and are damaged. It also can reveal problems with the heart's pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records whether the nuclear material is taken up by the heart muscle (healthy areas) or not (damaged areas). The camera also can evaluate how well the heart muscle pumps blood. This test can be done during both rest and exercise, enhancing the usefulness of its results.
- Coronary angiography (or arteriography). This test is used to check blockages and narrowed areas inside coronary arteries. A fine tube (catheter) is threaded through an artery of an arm or leg up into the heart. A dye that shows up on X ray is then injected into the blood vessel, and the vessels and heart are filmed as the heart pumps. The picture is called an angiogram or arteriogram.
Cardiac rehabilitation is a medically supervised program that helps improve the health and well-being of people who have heart problems. Rehab programs include exercise training, education on heart-healthy living, and counseling to reduce stress and help you return to an active life.
Each patient will have a program that's designed to meet his or her needs. Many people with heart problems can benefit from cardiac rehab. Rehab may help people who have had:
Cardiac rehab helps people who have heart problems:
- Recover after a heart attack or heart surgery.
- Prevent future hospital stays, heart problems and death related to heart problems.
- Address risk factors that lead to coronary artery disease and other heart problems.
- Adopt healthy lifestyle changes. These changes may include a heart-healthy eating plan, increased physical activity and learning how to manage stress.
- Improve their health and quality of life.
You can decrease your risk of chest pain by doing the following:
- Stop smoking. Smoking directly damages coronary arteries and decreases the amount of blood flowing through the artery. Smoking also damages the lungs and decreases the amount of oxygen available in the bloodstream. Smoking is one of the most dangerous things a patient at risk of heart disease can do.
- Gradually increase the amount of exercise you do each day. Exercise should be low-impact and should be increased gradually so as not to overstress the heart. Ask your physician what exercise would be appropriate.
- Modify your diet to limit intake of fats, saturated fats and cholesterol. Fats and cholesterol produce an accumulation of plaque in the coronary arteries and result in decreased blood flow. Saturated fat is referred to as "bad fat," whereas monounsaturated fats are referred to as "good fat." It is suggested that saturated fats be limited to less than 20 grams a day, total fat to less than 65 grams a day and cholesterol to less than 300 mg a day. This will help decrease the amount of cholesterol that causes increased plaque buildup.
- Lose weight if you are overweight. When you are overweight, the heart must work harder to pump blood through the body. This places you at risk for worsening heart disease. Adhering to a low-fat, low-cholesterol diet and gradually increasing your exercise are two good first steps to losing weight. Ask your doctor about a weight-loss regimen appropriate for you.
- Decrease the amount of stress in your life. Stress results in increased heart rate and blood pressure, which in turn cause the heart to work harder, requiring more blood flow. When coronary disease and plaque are present, the body is unable to supply adequate oxygen to the heart, resulting in chest pain. Your physician or nurse can make recommendations about reducing stress in your life and provide you with methods to better handle stress.