Chest pain may be the first warning that there is a problem with the blood supply of the heart. The heart is a muscle that is responsible for pumping blood around the body. Like all muscles when there is not enough blood supply to cope with demand, “cramp” develops and in the case of the heart muscle this is referred to as “angina”. The heart muscle is supplied by two arteries: The left and right coronary arteries. If there is an abrupt blockage in one of the arteries then chest pain can develop suddenly at rest and it is typically described “like someone pressing down on the chest” or a “squeezing sensation”. The pain can sometimes radiate to the neck or left arm and be associated with sweating, nausea and breathlessness. If you experience chest pain like this at rest then you must seek urgent medical attention as you may be having a heart attack (Myocardial Infarction).
Does chest pain always mean I am having a heart attack?
No, chest pain can also be due to other less serious conditions which may or not be related to the heart.
If you only have chest pains with exertion that are relieved by rest, this could be “stable angina”. This occurs as a result of furring up within the walls of the blood vessels that supply the heart. When you exercise the heart needs more blood but the flow of blood is limited by the narrowing resulting in the cramp like pain which is relieved when you stop what you are doing.
Is all chest pain as a result or problems with the heart?
No, the body is not very good at telling the difference between pain in the chest area caused by other less serious conditions so indigestion, or reflux of stomach acid, pain from the chest wall structures such as muscles and ribs joints can also cause chest pain.
Is stable angina serious?
Stable angina is not as serious as a heart attack however furring up of the arteries which is known as “atherosclerosis” causes coronary artery disease and does increase the risk of heart attacks. Diagnosing the condition is important because starting the correct treatment can significantly reduce the risk of heart attacks and prolong your life.
If I have no chest pain then I do not have any heart problems?
Unfortunately problems with the blood supply of the heart do not always declare themselves with chest pain. Some people have atypical symptoms. This is particularly the case with women and people with diabetes who may describe breathlessness with exertion rather than typical chest pain symptoms. Also if walking causes you to have chest pain or become short of breath it is natural to avoid exerting yourself, giving false reassurance that nothing is wrong.
So how do I find out whether the chest pain that I am having is a cause for concern?
The first step is to seek advice from a doctor. At Wiltshire cardiology you will be seen by an experienced specialist who sees many patients with chest pain. Once you book an appointment he will take a detailed history and if it is a face to face consultation examine you. Then you may require some further investigations such as an ECG, Echocardiogram. If you have not already had blood tests from you GP, these can be arranged. Based on this initial evaluation we may recommend no further investigations or tests which will determine whether you have any problems with the blood supply of your heart. These may include either, a CT coronary angiogram, stress echo, stress MRI, a coronary angiogram or a combination of these investigations.
What will happen if I do have coronary artery disease?
If you have coronary artery disease the treatment is aimed at: 1) reducing your risk of heart attacks, 2) relieving the symptoms of angina to improve your quality of life and 3) making you live longer (improving your prognosis).
In all people with coronary artery disease we recommend tablets which will deal with cholesterol (statins), reduce the chance of blood clots (Aspirin), and relieve the symptoms of angina (Betablockers, Nitrates etc). If you still experience symptoms then we may recommend that you may need a stent (a scaffold) that is inserted into the artery that is narrowed to reduce the narrowing. Sometimes the location and the number of the narrowed sections in the coronary arteries mean that stents are not possible and we may recommend referral to a cardiothoracic surgeon to consider a coronary artery bypass operation. These are all complex decisions and we will take the time to explain clearly the pros and cons of these approaches. Your views are also very important to guiding management and we always encourage shared decision making.
Are there any other treatments which do not involve tablets, stents or bypass operations?
There is a growing body of evidence that lifestyle changes can also help reduce the risks of coronary artery disease. As part of our holistic approach at Wilshire cardiology we can certainly offer guidance on the benefit of various mind and body interventions which are complimentary to the more standard allopathic treatments. However these approaches have far less robust evidence than established practices, which are based on a foundation of rigorous scientific data