Every chest pain is not a heart attack

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ALL that glitters is not gold and every chest pain is not a heart attack. It is not rare to see patients having chest pain panicking and living under the fear of death due to heart attack even when the cause of the pain is not in the heart but elsewhere. It is important to know the various causes of pain that may resemble cardiac pain so that this situation is avoided.

Ischaemic heart disease (IHD) literally means decrease in blood supply (ischaemia) causing disease of the heart. The commonest cause of IHD is coronary artery disease or, simply put, decreased blood flow to the heart due to the blockages in the blood vessels that supply oxygen and nutrients to the heart. IHD may cause mild chest discomfort, severe chest pain, heart attack or even sudden death. It progresses unless preventive methods are taken.

Blockage up to 40 or 50 per cent in the coronary arteries are widely prevalent but not sufficient to casue angina coronary artery disease does not cause any problem till the blockage is more than 70 per cent. Progress of blockages depends on how bad is the lifestyle of a person. Recognition of ischaemic heart disease depends on the patient's knowledge of the disease and his physical activity.

When there is discomfort due to the heart getting less blood supply but no death of the heart muscle, it is called angina. The onset of angina is usually on sudden excitement, anxiety, climbing stairs, walking, bathing or during stressful activity or minimal exertion after heavy meals. It may be precipitated by sudden coronary artery spasm due to stress. The pain of angina is mild to severe and occurs in the centre of the chest. It may extend to the left arm, right arm, shoulder, back or lower jaws. It usually lasts 5 to 10 minutes. It may be associated with breathlessness or shortness of breath, sweating, sensation of vomiting, dizziness or fainting.

There may be a choking sensation in the throat or heaviness in the upper abdomen. Some patients may simply have weakness and easy fatigability. The pain of angina is relieved on rest or with a tablet of Sorbitrate. The pain is never excruciating and does not stay for long (unlike in heart attack).

Heart attack occurs when the blockage in the coronary arteries causes complete obstruction of blood supply to a part of the heart muscle, resulting in the heart muscle being completely deprived of its blood and oxygen supply which leads to their death. It can be caused by decreased blood flow due to the sudden spasm of partially blocked arteries, sudden rupture of blockages due to its continuous expansion or coronary thrombosis. It may be precipitated by a heavy meal full of fat, sudden anger or excessive sorrow or grief or excessive stress, during angiography and angioplasty when the catheter or balloon is inflated or during bypass surgery.

Severity of a heart attack depends upon the area of the heart muscle involved. If only 5 to 10 per cent area is involved it is mild and most patients survive. If the dead area is more than 30 or 40 per cent the heart attack is usually severe with the possibility of death.

Heart attack can be recognised by the pain being very severe in nature that cannot be tolerated. It is associated with sweating, vomiting sensation, passing stool, dizzy or loss of consciousness. The symptoms usually last half an hour or more.

The conditions that are commonly confused with ischaemic heart disease are pain due to gastric acidity, ulcer or oesophagitis. However, in this case the discomfort is a burning sensation which may be spasmodic with no effect of exertion. The pain is not associated with breathlessness, radiation to arms, sweating and choking sensation, and there is no relief with rest or a tablet of Sorbitrate or spray.

Muscular pain in the chest muscles due to injury or sprain can also be confused with cardiac pain. However, there is usually a history of muscular pull or injury and is relieved by the application of pain ointments or taking a pain-killer.

Cervical spondylosis may also cause pain in the shoulder, left or right arm and chest pain. However, in this case the pain is continuously present in both the right and left side simultaneously and is relieved by pain-killer.

It is important to consult the doctor whenever there is chest pain, but your observation of its features is essential for him to diagnose your disease properly.

About the Author:

The writer is a Ludhiana-based specialist in non-invasive cardiology trained in England and China.

Sibia Medical Centre, B/XIX-573, Civil Lines, Ludhiana 141001 India
Mb: 0091-98140-34818, Ph: 0091-161-2444418, Fax: 0091-161-2444818 Email: sibia@vsnl.com, drsibia@sssibia.com, info@ecp-india.com Web: www.sssibia.com, www.ecp-india.com

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