1. Chest Pain at Rest is a Problem
Chest pain that develops at rest is a bad sign. This can be the beginning of a life-threatening emergency. Several things can cause chest pain. A few of them are can be fatal if they go untreated. The sudden onset of pain that is associated with problems breathing, sweats, nausea, or loss of consciousness requires an immediate call to 911. Things that can kill you include heart attack, aortic tear, lung collapse, pulmonary embolus and esophageal rupture. Do not ignore symptoms, because in the case of many of the above conditions delaying treatment reduces the chance of successful treatment.
2. Chest Pain with Exertion is Often Heart-Related
Chest pain with exercise or exertion is often related to narrowed arteries to the heart. This muscle pump supplies all oxygenated blood to your body. If the blood supply to the pump is compromised fully, this results in muscle damage that may be permanent. The result can be a weak pump and heart failure. When symptoms are confined to pain with exertion then the artery is narrowed approximately 80 percent or more. Symptoms will not be present at rest as the muscle does not demand more oxygen to function. On a treadmill or walking on an incline the muscle needs more blood and the supply can not meet the demand because of the narrowing. Medical treatment for "angina" includes aspirin, beta blockers, nitrates, angiotensin-converting enzyme inhibitors and statins. When these stable symptoms can not be controlled by the medications then an angioplasty and stent are needed.
3. Stress Testing and Chest Pain
If you have chest pain your doctor may want to send you for a stress test. This involves walking on a treadmill while an electrical tracing of the heart rhythm is recorded. At times the test involves taking a picture of the heart before and after exercise. If there is an artery narrowed in the heart the electrical tracing will develop characteristic changes consistent with low diminished blood flow. The degree of electrical changes, the duration and intensity of exercise and the presence or absence of chest pain with the test help to identify the risk of possible adverse cardiac events for the patient. The addition of an imaging study such as echocardiography or nuclear perfusion imaging increases the ability to detect or rule out narrowed arteries with a higher degree of certainty.
4. Don't Be Fooled by Chest Pain That Changes With Position
I often see younger patients in the emergency room with complaints of chest pain that changes or improves with movement. This type of pain often originates from the musculoskeletal system. It can be related to a pectoral (chest muscle) strain or pull. If the pain is following a viral syndrome or cold this could be caused by inflammation around the lining of the heart (pericardititis). This type of pain often responds to non-steroidal anti-inflammatory medications. It is important to seek medical attention for this type of pain if it is not improving or associated with trouble breathing, rapid heart beat, or low blood pressure. This could be a sign that there is a dangerous accumulation of fluid around the heart which could be life threatening. Finally, even if chest pains change with position it could be "the big one," so don't ignore it.
5. Cardiac Chest Pain Doesn't Have to Be Chest Pain
Many times I go to the ER to see a patient having a heart attack and often ask do you have chest pain? The look at me rather bewildered and say, "I don't have chest pain. I have chest pressure." It is classic to describe, an elephant sitting on my chest or a brick in the center of the chest. Unfortunately not every patient reads a medical textbook before going to the ER and the descriptions or chest pain can be, at times, bizarre. It is more likely to be an unusual presentation of a common medical condition than to see an uncommon medical condition. Other typical symptoms described that should not go ignored are burning epigastric pain, nausea, jaw pain, pain that radiates to the shoulder, back or neck and most importantly, any pain that seems to get worse with exertion such as walking or climbing stairs.
