Aug 24 (2 days ago)
Mr. Parikh wrote about people not seeking immediate medical attention, when faced with chest discomfort. They often confuse it with gas or muscle pain. I had written an article on the subject, and am sharing it here, since the topic has copy up.
Chest Pain: is it Angina or GasMr. Vasant Mehta was sitting at home after a heavy dinner and watching TV when he got some discomfort in the chest region. It persisted for a little while and then became less after he belched. But the pain came back after 15 minutes and it was more severe; his wife was worried and insisted on going to the hospital. At the hospital his ECG showed that he had a massive heart attack and was given life saving drugs in time.
The story of Mr. Mehta is very common across the world where chest pain is often thought to be due to ‘gas’ and is ignored, often with fatal consequences. So how does one know when chest pain is due to the ‘heart’?
What is Angina:
Angina is a pain or discomfort in the chest or adjacent areas caused by insufficient blood flow to the heart muscle. This chest pain is relieved by rest or medication within a short period of time (usually 15 minutes). Chest pain of a longer duration or pain appearing with a lower level of effort than before, even at rest, should be considered unstable angina.
Signs and Symptoms
- Squeezing pressure, heaviness, or mild ache in the chest (usually behind the breastbone) which is not clearly localized. It usually lasts 1 to 15 minutes.
However this is known as the ‘classical presentation’ and each person may have different symptoms. Other methods of presentation may be:
- Aching in a tooth with or without squeezing pressure or heaviness in the chest
- Aching into the neck muscles or jaw
- Aching into one or both arms
- Aching into the back
- A feeling of gas in the upper abdomen and lower chest
- A feeling that you're choking or shortness of breath
- Paleness and sweating
Chest pain or heaviness that is not relieved by more than 1 nitroglycerin tablet taken 5 minutes apart, and that lasts longer than 15 minutes may represent mean unstable angina or even a heart attack.
Episodes of angina are usually associated with:
- Anger or excitement
- Emotional shock
- Exertion or physical work, especially if it strains the muscles of the chest or arms
- Walking rapidly uphill
- Waking up at night with discomfort due to decreased blood flow to the heart
What is the difference between angina and a heart attack?The difference between angina and a heart attack is that a heart attack results in a damaged or injured heart muscle. Angina does not. Rather, anginal pain is a warning sign of a potential heart attack. The pain indicates that the heart muscle isn't getting enough blood.
It is hard, sometimes, to tell the difference between angina and a heart attack. A person may have to be given tests and be observed for a day in the hospital or emergency room to tell the difference.
Why does angina happen?
The most common cause is coronary artery disease , or what we commonly call ‘heart disease’. Blockages in the coronary arteries, called plaques, prevent an adequate amount of blood from reaching the heart muscle. Situations that require increased blood flow to the heart may cause angina in people with CAD. These include exercise, heavy meals, and stress.
Other Possible causes of Chest pain:
The following medical conditions are some of the common causes of Chest pain, besides angina. There are several other possible causes, so it is important to ask your doctor about your symptoms. Usually pain related
- Heart valve disorder
- Cervical spinal disorder
Treatment and Care
Seek emergency care for any chest pain which is suspicious for angina. Contact your physician or a cardiologist, who should insist on close follow-up, appropriate studies to diagnose your condition, and therapy to treat it. The keystones to treatment are:
- Medications such as:
- Nitroglycerin or sorbitrate (or other medication to temporarily dilate or widen the coronary arteries), which eases blood flow to the heart. Nitroglycerin takes effect within a minute or two.
- Medicine(s) to control high blood pressure
- Low-dose daily aspirin
- Daily physical exercise for endurance. Exercise must be maintained below the onset of any discomfort.
- Don't smoke. Nicotine in cigarettes constricts the arteries and prevents proper blood flow.
- Avoid large, heavy meals. Instead, eat lighter meals throughout the day.
- Rest after eating, or engage in some quiet activity.
- Minimize exposure to cold, windy weather.
- Lower your cholesterol level, if high, by eating a low-saturated-fat diet and/or taking lipid (fat)-lowering medication, if necessary and prescribed.
- Avoid sudden physical exertion, such as running to catch a bus.