Arun Agarwal, M.D., cardiologist [January 10 2013]
Not all chest pain is due to a problem with the heart. Chest pain or discomfort that is related to the heart is called angina. There are three main features of chest pain that help determine presence of angina:
1. Pain presents as pressure, heaviness, tightness that lasts 3-15 minutes and radiates to the left arm, neck, or jaw.
2. Pain is brought on by physical or emotional stress.
3. Pain is relieved when the stressor is gone or nitroglycerin is taken. Nitroglycerin is a medicine that helps relax and open up arteries in the heart.
All these components are present with classic or typical angina. If one or two components are present this is called atypical angina. When none of the components is present we call this nonanginal chest pain.
Typical angina can be stable or unstable. Stable angina is when the same level of exertion brings on the pain. For example, a patient may say, “Doctor, I only get my chest pain if I walk at a fast pace for three blocks or if I go up one flight of stairs.” Unstable angina is when the symptoms worsen over time.
But if your angina suddenly occurs after only one block of walking or at rest, or if nitroglycerin had previously relieved your angina but now it persists despite taking nitroglycerin under the tongue you may be having a heart attack and should immediately call your doctor or 911 or have someone take you to the emergency room.
Diagnostic testing. Generally, most patients have stable typical or atypical angina. Stable typical or atypical angina needs to be investigated further with heart tests such as a stress test or a heart catheterization, also known as an angiogram. Nonanginal chest pain does not require heart testing and other causes such as muscle problems, anxiety, lung problems, or acid reflux should be considered.
Therapy. Extent of artery blockage will determine therapy. If blockages are extremely severe and extensive, stents or even bypass surgery may be required. A stent is a small metal device that contains medicines to open up a blocked artery. During bypass surgery a surgeon takes veins and arteries from other parts of the body to bypass the blockages in the arteries of the heart. If the blockages aren't severe angina can be treated with medicines like aspirin, beta blockers, calcium channel blockers, ace inhibitors, and nitrates.
Dr. Arun Agarwal is a member of The Hospital of Central Connecticut (HOCC) medical staff. For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online.
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