Chest pain…
It may be nothing, but it may not be…
I’m not trying to scare you, but heart attacks are deservedly scary.
The standard advice is if you have chest tightness that lasts for more than 15 minutes is to call an ambulance. Particularly if the pain goes to your arms or neck, if you feel hot and sweaty, or if you feel dizzy. The pain may be in the upper abdomen and be confused with indigestion, or go through to the back. These are all worrying symptoms.
Heart attacks are due to a blockage of the heart arteries usually due to the lining of the artery breaking open and a clot forming. How severe the heart attack depends on the location of the clot (at the beginning of a large artery = large heart attack, at the end of a small distal branch artery = small heart attack), and on whether your body dissolves the clot by itself, or if it is unblocked by drugs or an angioplasty.
But the people I tend to see in clinic as opposed to the Emergency department are those who have less severe symptoms or have been to hospital and had a heart attack excluded.
Here there is time to take a proper story of the pain as this gives the answer in most people. The characteristics of pain due to heart artery narrowing are a dull heavy feeling in the centre of the chest, that can go up to the neck, jaw or left arm. It reliably comes on with exercise and goes away with rest. This classical history is almost certainly due to the heart, and is known as angina.
Obviously many people don’t have a classical history. Symptoms are often different in women, and in patients with diabetes.
In cases of clear angina it is sensible to do an angiogram to have a look at the arteries and identify narrowing. In cases where it is not clear it may be worth doing non-invasive tests to look for artery narrowing or the functional effect of narrowing. These investigations can determine if further medication, stents, or surgery is needed.
Other causes of chest pain include musculoskeletal problems, acid reflux or lung problems such as pleurisy pneumonia or clots.
If you are worried about chest pain, it is worth getting a specialist opinion. Feel free to contact me to arrange an appointment where we can spend some time going through your symptoms and deciding if you need any tests.