Chest pain: how to distinguish between cardiac and noncardiac causes. Dr.Magesh.T MD( USA) MRCP(UK)

Classic coronary pain–or angina–involves a substernal pressure that commonly begins with exertion and is relieved by rest. However, some patients experience angina in the absence of physical exertion or emotional stress, and not all chest pain that begins after exertion is angina. Atypical chest pain must be differentiated from other types of chest pain, including chest wall pain, pleurisy, gallbladder pain, hiatal hernia, and chest pain associated with anxiety disorders. Careful examination of the chest wall is essential, and abnormal heart sounds can tell you a great deal. Further testing is individualized. An exercise ECG is important in identifying the presence of ischemic heart disease and the amount of myocardium at risk. If the ECG is abnormal at rest, the patient should undergo a thallium stress test or exercise echocardiography. A coronary angiogram is indicated if the exercise test or an ECG during pain show that a lot of live heart muscle is at risk.

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What is Chest Pain?
Chest pain is a very common symptom; we see it in all kinds of patients and all kinds of forms. It can be described as a burning sensation, tightness, pressure, some people have heartburn-type symptoms, sometimes people just have shortness of breath or fatigue.

What do the symptoms mean?
It’s very difficult sometimes to tell when you are having these types of symptoms exactly what’s going on. Sometimes it could be something as benign as heartburn. But, other times it could be something much more serious, like heart disease. What usually happens is somebody needs to come in and be evaluated either by a physician or in a local emergency room.

When should I get help?
If you’re experiencing the above symptoms, and they’re persistent, I would recommend getting evaluated quickly. Getting to the nearest emergency room as soon as possible is important so that you can be evaluated further, and we can get a better idea of what’s going on.

What should I expect in the Emergency Department?
When you come to the emergency room, you will be brought back and evaluated by a nurse and physician, an EKG will be obtained as well as blood work, and further tests will be done so that we can get a better understanding of what the symptoms are and whether or not they’re truly related to a significant problem like heart disease. If after this evaluation it becomes clear that you are suffering from heart disease, you’ll need further treatment. Coronary angiography is a typical treatment plan which often times leads to balloon angioplasty or stenting. Sometimes, a patient’s heart disease is so severe that it will require bypass surgery.

More about Heart Care at CHI Health: https://www.chihealth.com/en/services/heart.html
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