Chest pain is it caused by the heart or something else?

Chest pain is it caused by the heart or something else?

Riyadh: Dr. Hassan Mohamed Sandakji
A fifty-five-year-old woman, usually with little physical activity, felt pain in the chest and left shoulder a few days ago while walking. When I stopped walking and rested, the pain eased. She did not seek medical help at that time. Then I came to the doctor's office after repeatedly suffering from the same pain while walking, which stops when resting and sitting.

A 66-year-old man with diabetes and high blood pressure came to the hospital's emergency department with severe chest pain, after an intense discussion with one of his sons. The patient says: “I feel pain as if it is crushing my chest and coming down to my left shoulder and my jaw.” When he attended, the doctor noticed that he was sweaty, pale and very anxious, and the patient also complained of shortness of breath with a feeling of nausea.

Another woman, who was obese and had obstructive sleep apnea, had sharp chest pain for half a minute and then the pain lasted less severely for about two minutes, when she was doing housework. Then the pain subsided and recurred the next day when she got out of bed, and then it was repeated throughout the pre-noon period. You don't experience shortness of breath, nausea, or sweating during these episodes of pain.

Another man, usually a heavy smoker, after eating a heavy meal and going out for a walk in the cold air, began to feel pain in the chest and upper abdomen, with shortness of breath. His pain increased to the point that he asked for help to come to the hospital emergency department. He was not taking any medications for his high blood pressure.

In all advanced cases and many others, the question comes to a person's mind: When is my chest pain serious? Is it angina or heart attack pain, or is it the result of something else, in the heart or outside the heart?

- Chest pain Chest

pain is one of the main reasons for patients to go to emergency departments in hospitals. Chest pain is a complaint that raises one specific question: Is the source of the pain the heart, or is there another source? And answering this question with certainty, is indeed very important in those moments. But it's a perplexing question, say Harvard cardiologists. They add, "Millions of Americans with chest pain are seen in hospital emergency departments every year. Millions of people - as well as doctors - face this perplexing question every year. What is the source of the problem? Chest pain can result from dozens of cases, in addition to angina and heart attack.”

And they add about the reasons for this confusion: “Some may then suffer from angina pectoris, which occurs when part of the heart (through the coronary heart arteries) does not get the amount of oxygen-rich blood it needs during periods of physical exertion or emotional stress. However, most of them may have a condition unrelated to the heart or arteries. The other difficult problem with chest pain caused specifically by coronary heart disease, is that different people experience it in different ways. While some people have classic chest pain (angina or heart attack), others have non-traditional, non-ideal forms, such as jaw pain or back pain. Others may just experience shortness of breath, extreme fatigue, or nausea.”

And unlike, say, knee or lower back pain, chest pain isn't something that can be ignored "until tomorrow." It is also not something that can be diagnosed at home. The advice, says Harvard cardiologists, is: “Don't play the doctor. See a doctor quickly if you are concerned about pain or discomfort in your chest, upper back, left arm, or jaw; Or you get cold sweats, nausea or vomiting. Call your local emergency number to call emergency medical staff. He will take you to the hospital in a car full of equipment that can start the diagnosis and keep you stable, if your heart is really having a problem.”

At the same time, these doctors offer a number of justifications for some patients not seeing the doctor, saying: “There are many reasons for delaying seeking medical help, including:

- I am too young to have coronary heart disease (however, even those in their 20s or 30s can have heart attacks).

I am in very good shape and have never complained before (a heart attack is sometimes the first sign of heart disease, not necessarily preceded by symptoms).

- I have a family to take care of at the moment (and this is all the more reason to head to the hospital quickly).

- I don't want to bother anyone (you'll be more inconvenient with advanced heart failure).


The American Heart Association (AHA) says: “Angina is chest pain or discomfort that occurs when the heart muscle does not get enough oxygen-rich blood. This is usually caused by narrowing or blockage of one or more of the three coronary arteries, or their main branches, also called ischemia. Angina pectoris can also be a symptom of coronary artery disease (the very small branches of one of the three large coronary arteries), which is more likely to affect women than men, called Cardiac Syndrome X. You

may feel pressure or squeezing your chest. This pain or discomfort can also occur in your shoulders, arms, neck, jaw or back. You may also feel angina pain in the form of "indigestion".

But angina is not a disease, but rather a symptom of an underlying heart problem, usually the result of coronary heart disease. In typical cases, angina pain occurs with physical exertion and subsides with physical rest, but there are many other types of angina, including microvascular angina, Prinzmetal's angina, and stable angina. Unstable angina, and variable angina pectoris. It is important to know the types of angina and how they differ.

Risk factors

The American Heart Association explains: “Depending on the type of angina you have, there are many factors that can lead to angina pain. Symptoms also vary based on the type of angina you have.”

The main risk factors for coronary heart disease include:

- unhealthy cholesterol levels

- high blood pressure

- smoking

- diabetes

- overweight or obesity

- metabolic syndrome (when three of these factors are present: increased abdominal circumference, high Triglycerides, low heavy cholesterol, high blood pressure, high blood sugar)

- lethargy from physical activity

- unhealthy nutrition

- getting old

A family history of early heart disease (before age 55 for male relatives, before age 65 for female relatives).

She adds by saying what is the summary: All chest pain should be examined by a health care provider. If you have chest pain, your doctor will want to know if your chest pain is angina. If so, your doctor will want to know if your angina is "stable" or "unstable". If the condition is "unstable" angina pain, you may need emergency medical treatment to try to prevent the condition from worsening to a heart attack.

Multiple characteristics of heart pain

When you complain of chest pain, your doctor will perform a clinical physical exam and ask about your symptoms, specifically these six key questions:

- How long have you had this condition?

Where are the pain points?

On a scale from 1 (mild) to 10 (critical), what is your level of pain and discomfort?

What behavior (or behaviors) triggers the pain? Is it: doing physical activity? or eat? Or emotional outburst? Or the practice of emotional meeting with the wife?

How long has the chest pain lasted?

What do you notice that if you did it, your pain and discomfort eased? Is it physical rest, or taking the "pink pill" (Nitroglycerin) that is placed under the tongue?

Chest pain is more likely to occur due to coronary heart disease (angina or heart attack) when it has the following characteristics:

Pain, pressure, tightness, squeezing, or burning in the chest

A gradual onset of pain over a few minutes

Diffuse pain, including persistent pain in the middle of the chest

Pain that radiates to the left arm, neck, jaw, or Back

Pain or pressure accompanied by other signs, such as difficulty breathing, cold sweats, or sudden nausea

Pain or pressure that appears during or after physical exertion or emotional stress

and chest pain is not likely to be due to coronary heart disease (angina or heart attack) When it has the following characteristics:

- sharp, knife-like or needle-stick pain, caused by breathing or coughing

- sudden stabbing pain that lasts only a few seconds

- pronounced pain on one side or the other

- localized pain in one small spot

Pain that lasts for several hours or days without any other symptoms

Pain caused by pressure on the chest or movement of the body

14 other causes of chest pain

It is common, and also useful and clever, to believe that chest pain is likely a sign of coronary heart disease, until proven otherwise. It is true that tests in 13% of emergency room visits for chest pain prove that it is related to the heart arteries, but there are also additional and “important” reasons that may make a person feel chest pain. Some of them have to do with other parts of the heart than the cardiac arteries, and some of them have to do with other structures in the chest or abdomen. Examples include:

- Lung embolism (blockage in the pulmonary artery)

- Aortic dissection (a tear in the layers of the wall of the main aortic artery)

- Inflammation of a microbial infection of the lung (pneumonia)

- Aortic valve stenosis (narrowing of the aortic valve of the heart)

- Hypertrophic cardiomyopathy (disease of enlarged heart muscle in areas affecting the blood flow from the heart)

- Pericarditis (inflammation of the tissues surrounding the heart)

- Myocarditis (possibly due to a viral infection)

- Psychological panic attack

- Indigestion

- Leakage of stomach acid into the esophagus

- Swallowing disturbances due to constriction of sections of the esophageal muscle

- Heart rhythm disturbances (both Feeling of throbbing or otherwise)

- Problems of the neck vertebrae

- Muscular tension or tearing of the chest or neck muscles.
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