1. What is chest pains?

Doctors almost always refer to chest pains of cardiac cause due to obstruction in the heart arteries as "angina". In the real world however, many patients deny any pain as a description, but rather would described it as "chest discomfort, heaviness or tightness" that is usually associated with breathing difficulties or shortness of breath (as if an "elephant" is sitting on the chest), cold clammy perspiration and numbness that may radiate to the left arm, neck, the left shoulder and in rare instances to the lower jaw simulating a toothache. I have seen patients going to the dentist thinking they have a tooth problem when in fact they are suffering from angina or cardiac chest pain.

2. What is the cause of chest pains?

This discomfort is due to lack of oxygen supply to the heart muscle which if prolonged long enough may cause the heart muscle to die. In medical terms this is called " acute myocardial infarction" The presence of blockage in the heart arteries is called "coronary artery disease" caused by cholesterol deposits.

3. Why we should not ignore if we are having chest pains?

As a rule, the earlier treatment is instituted, the better it is for the patient. The longer the loss of oxygen supply to the heart muscle, the more heart muscle dies and the poorer is the long term outlook. The earlier coronary blood flow is restored , the better it is for the patients overall prognosis.

4. Are all chest pains the same?

Absolutely not, a significant number office consults that I get are due to "atypical chest pains". These are called noncardiac causes of chest pains. I call it "benign nuisance" because this is merely a false alarm and yet it can cause a significant degree of alarm and anxiety on the patient.

5. What are the causes of "atypical chest pains"

A fairly common form of chest pain that doctors encounter in their practice is due to costochondritis . Other causes of non cardiac chest pains are due to chest muscles, esophageal spasm and on rare cases due to various lung conditions.

6. How do we know if we have a real cardiac pain?

The clinical manifestations of angina or "cardiac chest pain" is due to blockage or narrowing of the coronary artery that leads to a reduced oxygen delivery to the heart muscle. If there is indeed critical narrowing, chest pains are usually precipitated by exertion that gets relieved with rest or taking sublingual nitroglycerine. This is called typical angina or stable angina.

7. What are the common causes and how to characterize noncardiac chest pains?

Costochondritis: Localized pain and tenderness on pressure on the chest wall and sometimes pain is worsened with inspiration.

Muscle pain: Generally it follows a bout of strong cough that leads to excessive muscle contraction and leads to a condition called myalgia. Any effort that uses these muscles would provoke chest pain or discomfort.

Esophageal Spasms: These are strong and exaggerated contractions of the esophagus that can trigger severe chest pains. This may respond to sublingual nitroglycerine which may be confused for the real thing. Differentiating from the real cardiac angina may require additional work up that may including ECG plus other studies directed towards esophageal causes.

8. Why should go to the hospital as soon as possible?

The best time to get helped is the first few hours following a heart attack because, there are now treatment and intervention protocols that have proven to save lives if administered in the early, generally within 6hrs if indeed you are having a heart attack. If there is a slightest doubt about your pain, it is best to get a medical evaluation by a competent physician preferably a cardiologist as soon as possible.

9. What are the risk factors for coronary artery disease?

There are many risk factors considered to be associated with coronary artery disease (CAD) but I would like to highlight the following: Diabetes Mellitus, Relatives with premature CAD <55yo>. CAD is accelerated further if you smoke, have hypertension and high cholesterol. Diabetes mellitus should not be taken lightly because as much as 40% of diabetics may suffer " silent heart attack", in short you may have had a heart attack that you may not know because the usual warning signs are not there. If you are a diabetic, don't take comfort just by the fact that you are feeling "okay" because the traditional symptoms maybe absent and special tests maybe needed for these select group of patients.

10. How is coronary artery disease diagnosed?

We generally start with noninvasive work up including treadmill stress testing, with our without imaging modality i.e. echocardiogram, radionuclide perfusion imaging studies. If the test show positive results for the disease, you maybe required to undergo a confirmatory procedure called coronary angiography. This test will tell us the extent and severity of the disease and in a way would guide us on what is the best modality of treatment that would suit for a particular situation. A new diagnostic modality called CT angiography has recently been available with high speed 64-slice CT scan (available here in Cebu City) but it is purely diagnostic modality with no therapeutic option possible and therefore, if the index of suspicion is really high, invasive coronary angiogram is generally considered the procedure of choice.

For questions and inquiries email: EdgarTanMD@gmail.com