Diagnosing Chest Pain -- August 4, 2008 -- Dr. Bo Walpole & Dr. Nigel Fontenot - NewsChannel5.com | Nashville News, Weather & Sports

Diagnosing Chest Pain -- August 4, 2008 -- Dr. Bo Walpole & Dr. Nigel Fontenot

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MEDICAL MONDAYS News Notes
Howard ‘Bo' Walpole, MD, cardiologist
Nigel Fontenot, MD, emergency medicine
TOPIC: Diagnosing Chest Pain

SAINT THOMAS HEART
August 4, 2008

Heart Disease: Angina

The most common symptom of coronary artery disease is angina or "angina pectoris," also known as chest pain. Angina can be described as a discomfort, heaviness, pressure, aching, burning, fullness, squeezing or painful feeling. Often, it can be mistaken for indigestion.

Angina is usually felt in the chest, but may also be felt in the shoulders, arms, neck, throat, jaw or back.

If you have this symptom, take notice. If you've never been diagnosed with heart disease, you should seek treatment immediately. If you've had angina before, use your angina medications as directed by your doctor and try to determine if this is your regular pattern of angina or if the symptoms are worse. (This is called unstable angina, see below.)

What Causes Angina?

When blood flow to an area of the heart is decreased, it impairs the delivery of oxygen and vital nutrients to the heart muscle cells. When this happens, the heart muscle must use alternative, less efficient forms of fuel so that it can perform its function of pumping blood to the body. The byproduct of using this less efficient fuel is a compound called lactic acid that builds up in the muscle and causes pain.

What Are the Types of Angina?

The types of angina are:

  • Stable angina. The pain is predictable and present only during exertion or extreme emotional distress, disappearing with rest.
  • Unstable angina. This may signal an impending heart attack. Unstable angina is angina pain that is different from your regular angina pain or pain that occurs while at rest. The angina may occur more frequently, more easily at rest, feel more severe, last longer, or come on with minimal activity. Although this type of angina can often be relieved with oral medications (medicine taken by mouth), it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required.
  • Prinzmetal's angina. This is when angina occurs at rest, when sleeping, or when exposed to cold temperatures. In these cases, the symptoms are caused by decreased blood flow to the heart's muscle or from spasm of the coronary artery. The majority of people with this type of angina also have coronary artery disease. These spasms occur close to the blockage.

Can Angina Occur In the Absence of Coronary Disease?

Rarely, angina can occur in the absence of any coronary disease. People with a heart valve problem called aortic stenosis have decreased blood flow to the coronary arteries from the heart. People with severe anemia may have angina because their blood doesn't carry enough oxygen. People with thickened heart muscles need more oxygen and can have angina when they don't get enough oxygen.

How Is Angina Evaluated?

First, your doctor will ask you a series of questions to determine what your symptoms are and what brings them on. After examining you, your doctor will order one or more of a series of tests to determine the underlying cause of the angina and the extent of coronary artery disease, if present. These tests include:

How Is Angina Treated?

The treatment you receive depends on the severity of the underlying problem, namely the amount of damage to the heart. For most people with mild angina, a combination of medications and lifestyle changes can control the symptoms. Lifestyle changes include: eating a heart-healthy diet, lowering cholesterol, getting regular exercise, quitting smoking and controlling diabetes and high blood pressure.

Some medications used to treat angina work by either increasing the amount of oxygen delivered to the heart muscle or reducing the heart's need for oxygen. These medicines include:

Others work to prevent the formation of blood clots, which can further block blood flow to the heart muscle. These medicines include:

For people with more serious or worsening angina, your doctor may recommend treatment to open blocked arteries. These include:

What Should I Do if I Have Angina?

With any type of angina, stop what you are doing and rest.

If you have been prescribed a medication called nitroglycerin to treat your angina, take one tablet and let it dissolve under your tongue. If using the spray form, spray it under your tongue. Wait five minutes.

If you still have angina after five minutes, take another dose of nitroglycerin. Wait another five minutes and if angina is still present, take a third dose.

If you still have angina after resting and taking two doses of nitroglycerin or 15 minutes, call for emergency help (dial 911 in most areas) or have someone take you to the local emergency room.

If you think you are having a heart attack, do not delay. Call for emergency help right away. Do not drive yourself to the hospital. Consider taking an aspirin. Quick treatment of a heart attack is very important to lessen the amount of damage to your heart.

Why Shouldn't I Drive Myself or Have Someone Drive Me to the Hospital?

When the ambulance arrives, the emergency personnel can begin to give you heart-saving care right away. They can start an IV to give you important drugs and give you oxygen to help improve the flow of oxygen-rich blood to your heart. Should problems occur, they are there to provide life-saving help as well.

Heart and Cardiovascular Diseases

When you think of heart disease, usually people think of coronary artery disease (narrowing of the arteries leading to the heart), but coronary artery disease is just one type of cardiovascular disease.

Cardiovascular disease includes a number of conditions affecting the structures or function of the heart. They can include:

Cardiovascular disease is the leading cause of death for both men and women in the U.S. It is important to learn about your heart to help prevent heart disease. And, if you have cardiovascular disease, you can live a healthier, more active life by learning about your disease and treatments and by becoming an active participant in your care.

Coronary Artery Disease

Coronary artery disease (CAD) is atherosclerosis, or hardening, of the arteries that provide vital oxygen and nutrients to the heart.

Abnormal Heart Rhythms

The heart is an amazing organ. It beats in a steady, even rhythm, about 60 to 100 times each minute (that's about 100,000 times each day!). But, sometimes your heart gets out of rhythm. An irregular or abnormal heartbeat is called an arrhythmia. An arrhythmia (also called a dysrhythmia) can involve a change in the rhythm, producing an uneven heartbeat, or a change in the rate, causing a very slow or very fast heartbeat.

Heart Failure

The term "heart failure" can be frightening. It does not mean the heart has "failed" or stopped working. It means the heart does not pump as well as it should.

Heart failure is a major health problem in the U.S., affecting nearly 5 million Americans. About 550,000 people are diagnosed with heart failure each year. It is the leading cause of hospitalization in people older than 65.

Heart Valve Disease

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood-flow through your heart.

Examples include mitral valve prolapse, aortic stenosis, and mitral valve insufficiency.

Congenital Heart Disease

Congenital heart disease is a type of defect in one or more structures of the heart or blood vessels that occurs before birth.

It affects about 8 out of every 1,000 children. Congenital heart defects may produce symptoms at birth, during childhood and sometimes not until adulthood.

In most cases scientists don't know why they occur. Heredity may play a role as well as exposure to the fetus during pregnancy to certain viral infections, alcohol, or drugs.

Cardiomyopathies

Cardiomyopathies are diseases of the heart muscle itself. People with cardiomyopathies -- sometimes called an enlarged heart -- have hearts that are abnormally enlarged, thickened, and/or stiffened. As a result, the heart's ability to pump blood is weakened. Without treatment, cardiomyopathies worsen over time and often lead to heart failure and abnormal heart rhythms.

Pericarditis

Pericarditis is inflammation of the lining that surrounds the heart. It is a rare condition often caused by an infection.

Aorta Disease and Marfan syndrome

The aorta is the large artery that leaves the heart and provides oxygen-rich blood throughout the body. These diseases and conditions can cause the aorta to dilate (widen) or dissect (tear), increasing the risk for future life-threatening events, such as:

  • Atherosclerosis (hardening of the arteries).
  • Hypertension (high blood pressure).
  • Genetic conditions such as Marfan Syndrome.
  • Connective tissue disorders (that affect the strength of the blood vessel walls) such as, scleroderma, osteogenesis imperfecta, polycystic kidney disease, and Turner's syndrome.
  • Injury.

People with aorta disease should be treated by an experienced team of cardiovascular specialists and surgeons.

Other Vascular Diseases

Your circulatory system is the system of blood vessels that carry blood to every part of your body.

Vascular disease includes any condition that affects your circulatory system. These include diseases of the arteries and blood flow to the brain.

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