Chest Pain: Is It Heart Problem?

Chest Pain: Is It Heart?

Angina - precursor to "heart attack"

Angina is caused by narrowing of the coronary artery (which supply blood to heart muscle) which leads to temporary lack of blood/oxygen supply to the heart muscle when the demand for oxygen increases (during exertion). Thus, it is a condition of increased demand but limited supply of blood/oxygen.

     Narrowing of coronary artery causing angina

Typical angina is described as "pressing", "gripping", "tight" chest pain located at the center of chest which may radiate to the neck/jaw/left upper arm. This pain usually comes on exertion (physically or emotionally) and disappears during rest, and usually last <5min. This is referred as "stable angina".

If this is the first time you encounter this type of pain, you should see a doctor to have further evaluation on the pain. Doctor will usually arrange an appointment for exercise stress test / CT angiogram / percutaneous angiogram depends on your risk factors & preference.

If you are already known to have coronary heart disease, you can take the medicine under the tongue (nitroglycerin). If the pain is not relieved by the medicine, or last longer, or is more severe or more frequent than it used to be, you should go to hospital immediately for treatment as this may indicate more advance artery occlusion. This is referred as "unstable angina".

Myocardial infarction - true heart attack

Heart attack means that the already-narrowed coronary artery is suddenly blocked 100% (usually by a clot) causing heart muscle to die. In this case, more & more heart muscles are dying every second and that's why time is very crucial. The faster the sufferer gets treatment to open up the blockage, the higher the chance of survival and the better the outcome.

     Total occlusion of coronary artery causing heart attack

The nature of chest pain of heart attack is similar to angina but it is usually more severe and is commonly associated with other symptoms such as sweating, shortness of breath, dizziness, fainting, nausea etc. It can occur during exertion or even suddenly at rest (eg during sleep). However, sometimes the pain can be atypical and some elderly or diabetic patients may not feel the pain at all.

If you suspect yourself to have heart attack, please get someone else to drive you to nearest hospital as soon as possible, as every seconds count.

Aortic dissection

Another rare but important cause of chest pain is aortic dissection. It is important as it is life-threatening. In aortic dissection, the wall of aorta (which transport blood out of the heart to other body parts) is torn or seperated. Thus, it is usually described as severe "sharp" & "tearing" chest pain which may radiate to the back.

     Tearing of aortic wall

If the chest pain you experience is not the same as described above, it doesn't mean that it is not originating from the heart. When you are in doubt, always seek for medical attention.

There are other causes of chest pain related to the heart, such as infection or inflammation of the 3 layers of heart wall - endocarditis, myocarditis & pericarditis.

Click here for clues on how to differentiate chest pain.