Chest Pain - What you need to know
Dear Dr Makis,
I have recently been experiencing pain in my chest. I have been to see my doctor about it who said it’s likely to be indigestion and has given me some medication for this. I’m still worried its coming from my heart. Both my parents had angina and I’m still worried this is coming from my heart, is there anything else I should be doing to check this out?
Chest pain is a common and often worrying symptom because it can be a sign of a problem with the heart including coronary artery disease which is the cause of the symptom of angina. There are many causes of chest pain and indigestion is one of the most common. Your doctor will have asked you the relevant questions during your consultation with them. This would allow them to feel confident that your symptoms are not coming from your heart and caused by indigestion. However, given your family history, it is important to know what to look out for if chest pain is caused by coronary artery disease and what to do if this is the case.
Angina is the name of the pain that we experience if there is pain that comes from your heart. This is commonly caused by narrowing of the arteries that supply blood to your heart muscle. If your arteries are narrowed the reduced blood supply can result in not enough oxygen getting to your heart. The blood supply may be good enough when you are resting. When your heart works harder (when you walk fast or climb stairs and your heart rate increases) your heart muscle needs more blood and oxygen. If the extra blood that your heart requires cannot get past the narrowed coronary arteries, the heart responds with pain. Typical symptoms include pain, ache, discomfort, or tightness that you feel across the front of the chest. The pain is usually worse when you exert yourself. For example, when you walk up a hill or against a strong, cold wind. You may also, or just, feel the pain in your arms, jaw, neck or stomach. Angina pain does not usually last long, it will usually ease within 10 minutes of rest. Some people with angina also become breathless when they exert themselves. Occasionally, this is the only symptom and there is no pain.
It can sometimes be very difficult to differentiate between angina and other causes of chest pain so further tests can be done to help with this. This includes Blood tests to check for anaemia, thyroid problems, kidney problems, high blood sugar (glucose) level and a high cholesterol level, as these may be linked with angina. A tracing of the electrical activity of your heart may also prove beneficial. This is called an electrocardiogram or
ECG. This can often be normal at rest. In many cases doctors make the diagnosis based on the typical symptoms. No further tests may then be necessary. Tests are advised in some cases when the diagnosis is not clear, or sometimes to assess the severity of the condition.
If you have any of the symptoms that I have outlined, then you should see your doctor again to discuss this further. If your doctor thinks you may have angina, then you will be referred to a cardiologist who may arrange further investigations and then decide on what treatment you may need.
If a diagnosis of angina has been made that is caused by narrowing of the coronary arteries then you will be advised given certain medication to help lower your cholesterol, blood pressure and heart rate. You are likely to be started on aspirin to make your blood less sticky which helps prevent the formation of plaques that narrow your arteries. You will also be advised on certain lifestyle measures including stopping smoking, reducing your weight, reducing your alcohol intake, improving your diet and increasing your exercise levels if this is relevant to you.
In most cases, angina pains come on with a certain amount of exertion and you can predict the level of exertion that triggers a pain. This situation is called stable angina. It is common to have stable angina for many years and, with treatment, most pains can be prevented. Over months or years the pains may come on with a lesser amount of exertion if the condition gradually becomes worse.
If the pattern of your pain changes fairly suddenly and the pains develop after minimal exertion, or while you are resting, this is called unstable angina. This is an emergency and needs immediate medical care. If you have a pain that lasts longer than 10 minutes, or is different or more severe than usual, call an ambulance immediately. It may be unstable angina or a heart attack and immediate medical care is needed.
Hope that this gives you some more information about angina, if you do have any of these symptoms then your should be speaking with your doctor once again.
Dr Makis offers medical advice via his monthly article in the Paphos Post newspaper. If you require personal medical advice, contact your own GP in the first instance. For further information about Veramedica Medical Center, please contact us.