Chest pain: What to do

ESCANABA – As most of us know, chest pain is a major symptom of a heart attack. Doctors stress that there is no time for second guessing or denial when that or any other symptom presents itself. Patients should be taken directly to the nearest emergency department, preferably by ambulance.

However, it should be remembered that 1) chest pain is not the only sign of a heart attack; 2) it is not even the most common sign in females and 3) there are many possible reasons for chest pain, not all of which are even heart-related.

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.

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.

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 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, including weight loss, regular exercise, a better diet and 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.

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. If the blockage is not cleared and blood flow restored within a short time, that part of the heart will become damaged or destroyed.

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. Some persons report shortness of breath as the major symptom. Other symptoms include nausea, fatigue, sweating, light-headedness, weakness and confusion.

OTHER CAUSES OF CHEST PAIN: There are many other causes of chest pain. 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. 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 and gastroesophageal reflux (heartburn) are often mistaken for angina. On the other hand, heart attack patients can mistakenly dismiss ischemic chest pain as heartburn.

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 painoften a deep chest ache plus fever, chills, coughs and coughing up sputum.

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.

If symptoms such as these take you to the emergency room, there is no need to be embarrassed. As most emergency department physicians will tell you, being embarrassed but alive is much better than the alternative!

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EDITOR’S NOTE: Health Update appears weekly in the Daily Press and features local health professionals. Dr. Olsen is a board certified family practice physician with OSF St. Francis Hospital & Medical Group. He sees patients at the OSF Medical Group Clinic in Gladstone.)