How to know if chest pain is due to heart disease or not? Cardiology Basics

How to know if chest pain is due to heart disease or not? Cardiology Basics

It is not always possible to be certain about the origin of chest pain just by its characteristics as the variation between individuals is quite a bit. There can be a lot of overlap between symptoms due to heart disease and disease of other nearby organs.

Still some general observations are possible regarding chest pain originating from the heart. The typical pain of cardiac origin is a central chest pain which occurs on walking or other forms of exercise, known as effort angina. This pain is caused by insufficient blood supply to a region of the myocardium. Effort angina is commonly due to significant obstruction to a coronary artery. The pain can radiate to the neck, lower jaw, arms and upper abdomen. Occasionally, pain may be felt only at these regions, without pain in the chest. Then it is known as anginal equivalent. A heavy meal may also bring out similar pain as cardiac output increases during the digestive process due to enhanced splanchnic blood flow. This is known as postprandial angina and often indicates multivessel coronary artery disease. Pain is likely to be more if you are walking after a heavy meal. Pain occurring after a meal is likely to be mistaken to be gastrointestinal disorder.

Pain of effort angina will be more when you are walking uphill rather than downhill, due to the higher level of exertion. It can also be more when you are walking against the wind and while carrying a load. If pain starts occurring at a lower level of activity than before, it means that the obstruction in the coronary artery is progressing. A fall in level of hemoglobin in the blood due to loss of blood from any part of the body can also increase the pain. Effort angina is usually promptly relieved by rest or nitrates.

Pain of myocardial infarction occurs in a similar location as effort angina, but is more severe. A pain lasting more than 30 minutes is usual. Chest pain may be associated with undue sweating, anxiety and palpitation. But these symptoms can also occasionally occur due to severe anxiety and panic. Chest pain of myocardial infarction is not relieved by rest unlike effort angina. Though it may start after an unaccustomed exertion, it will not stop on taking rest. Prolonged chest pain calls for early hospitalization as time is muscle in case of myocardial infarction, mandating early management, typically by primary angioplasty. Travel should preferably be in a well equipped ambulance as it will ensure emergency care en route and faster reception at the emergency room. Driving alone to the hospital should be avoided at all costs as it can be catastrophic, due to the potential risk of life threatening cardiac arrhythmias in the early phase of acute myocardial infarction.

Another type of pain originating from the heart is due to pericarditis. This pain occurs continuously and may increase on deep breathing like pain originating from the pleura. Pain may be relieved on leaning forwards. Pain of pericarditis can increase on swallowing or odynophagia and mimic pain from the oesophagus. This is because the oesophagus is just posterior to the heart and food traveling through the oesophagus presses on the inflamed pericardium.

A still rare, but very dangerous condition is an aortic dissection. Dissection of aorta causes severe pain in the upper part of chest or more often in upper back. Pain of aortic dissection is tearing type and is most severe at onset. As it is a very severe disease process with high mortality unless early surgery is done, emergency hospitalization is needed.

Very transient catching type of chest pain could be insignificant and occur from the muscles of the chest wall. Pain originating from the muscles, bones and joints are usually aggravated by local movements or manual pressure. Passive movement of the painful muscle or joint will also produce pain. In case of pain originating from the heart, pain occurs even when you exert with the legs, while pain originating from the chest muscles is unlikely to increase with leg exercise. Pain from the chest muscles can increase with arm exercise as some major muscles needed for arm exercise are attached to the chest.