Chest pain – How to know if it is due to the heart?

First published in Beyond India, December 2016 edition.

Dr Varun Sharma – Cardiothoracic surgical registrar

Dr Ravi Iyer – Consultant cardiologist

In this article from the Australian South Asian Healthcare Association (ASHA) we discuss the symptom of chest pain and what to do about it.

I have been getting chest pain recently – is it serious?

Chest pain is a serious symptom that can have several underlying causes. Most of these are related to the heart, lungs, chest wall muscles, ribs, or stomach. Chest pain from the heart is the most important as it can be a warning sign of narrowing in your heart arteries or of a life threatening heart attack. Chest pain coming from the other organs may be severe though less often life threatening.

Why is chest pain so concerning?

The biggest concern with chest pain is a problem with your heart. Chest pain coming from the heart can be potentially life threatening. Coronary artery problems are the biggest concern because blockages in the blood vessels supplying the heart can lead to serious damage or even death to parts of your heart, which can then have an impact on the heart tissue, valves or conduction system. The most serious problem arises when there is sudden complete blockage of the heart arteries, also known as a myocardial infarction or what is more commonly called a heart attack.

How do I know it’s from my heart?

Symptoms for blockages in the arteries supplying your heart can vary a lot.

When the coronary arteries get narrow slowly over a period of time due to cholesterol plaque build-up, patients get symptoms only when the coronary artery gets critically narrow. The symptoms mostly consist of chest pain/left arm pain on exertion or shortness of breath on exertion, which get relieved with rest. In medical terms this is called angina. Unusual symptoms include decreased exercise capacity or excessive sweating on exertion.

When the coronary artery gets blocked off suddenly it causes symptoms of acute chest pain, heaviness or pressure on the chest, sudden shortness of breath, heart burn, profuse sweating, nausea, light-headedness, or discomfort in one or both arms, back, neck, or jaw. Sometimes it can cause the heart to stop (a cardiac arrest) and hence a life threatening situation. 25% of patients with a heart attack do not reach the hospital as they may die suddenly due to a cardiac arrest.

Sometimes the heart attack may not be sudden and one may get enough warning signs to enable one to come to the hospital. Many heart attacks start slowly as mild chest pain or discomfort, which builds in intensity over a period of time. Commonly, patients consider the symptoms as caused by heartburn and hence don’t come to the hospital on time. Studies have shown that people often delay seeking help for a heart attack because they thought the symptoms were not serious or would go away.

Is there anything else that can cause chest pain?

Chest pain can also be caused by inflammation/infection of the lungs, gastritis or stomach ulcers, fibromyalgia, inflammation of the ribs, intercostal nerves and abdominal problems.  However, the symptoms can be non-specific, and one should get early medical help.

So if I get chest pain, what should I do?

Any chest pain warrants medical attention. Non-specific chest pain can be dealt with by your general practitioner. However if the pain is typical of angina (central chest pain, left arm pain or shortness of breath on exertion) one will need to consult a specialist cardiologist.

If the chest pain is sudden in onset associated with sweating, nausea vomiting and making you feel very unwell it is better to call 000 immediately for an emergency ambulance. Avoid driving yourself to the hospital.

Irrespective of the underlying cause, immediate measures are targeted at diagnosing and treating heart-related causes as these are the most serious.