CARDIAC CAUSES OF CHEST PAIN
Stable angina is pain, pressure, or a sense of heaviness in the chest beneath the breastbone. It is brought on by physical exertion and is relieved by rest. The discomfort or pain may also be felt in the left arm or shoulder, the neck, the lower jaw. These are all areas of the body supplied by the same nerve that goes to the heart.
What is going on in the body?
Atherosclerosis, or hardening of the arteries, is a condition in which fatty deposits, also called plaque, form inside blood vessel walls. Atherosclerosis that involves the arteries supplying the heart is known as coronary artery disease. Plaque can block the flow of blood through the arteries. The tissues that normally receive blood from these arteries then begin to suffer damage from a lack of oxygen. When the heart does not have enough oxygen, it responds by causing the pain or discomfort known as angina.
What are the signs and symptoms of the condition?
Symptoms of angina include:
· Chest pain or discomfort that is bought on by exertion but goes away with rest.
· Palpitations or an unusual awareness of the heart beating in the chest.
How is the condition diagnosed?
Angina is usually diagnosed by a history of chest discomfort that is caused by exertion but goes away with rest. A physical exam may reveal signs of hardening of the arteries. An electrocardiogram, or ECG, is a recording of the heart’s electrical activity. An ECG is usually normal when a person has no pain, and it shows certain changes when pain develops. An ECG done during the exercise will show similar changes even before angina develops. This is known as the TMT or the tread mill test.
A cardiac catheterization, or coronary angiogram, is a procedure that is used to look for narrowed coronary arteries. A contrast agent is injected into an artery and X-rays are then taken. This procedure can be used to find narrowed blood vessels supplying the heart. But this procedure is an invasive test and the blockages are estimated by visual interpretation only. This is why they are defined as 70%, 80%, 90%, 99% and so on. The estimations can vary from expert to expert where as they could be 72% or 86.56% also. Moreover this procedure is done only to prepare the patient for revascularization surgeries like ballooning or bypass which are only temporary processes to relieve the angina. Hence this test is not generally advised by SAAOL which aims at reversal of heart disease only.
Other cardiac reasons for chest:
Myocarditis: It is an inflammation of the heart muscle from any cause. Inflammation can change the heart in many ways. It can make it weaker and affect the way it functions. Inflammation can cause certain areas of the heart muscle to die. Sometimes only a small area is affected, but serious cases may involve the entire heart. Symptom wise, besides chest discomfort it may cause fatigue or weakness. Other symptoms and signs may include:
· Sore throat, fever, or cough that begins several days to weeks before other symptoms start.
· Congestive heart failure, a condition that weakens the heart so that it cannot pump hard enough to circulate blood effectively.
Chest Pain
· Shortness of breath.
· Palpitations, or an unusual awareness of the heartbeat.
· Rapid heartbeat, known as tachycardia.
· Arrhythmia, or abnormal heartbeats.
· Heart murmurs, or abnormal heart sounds.
There are many causes of this condition including:
a. Infections, usually with a virus.
b. Autoimmune disorders, such as rheumatoid arthritis, which occur when a person’s immune system attacks his or her own body.
c. Radiation therapy, which may be given to treat cancer in the chest.
d. Exposure to chemicals or drugs, such as cocaine or a medication used to treat cancer, called doxorubicin.
e. Pregnancy, which can very rarely produce severe inflammation of the heart.
Other causes are possible, and sometimes the cause is unknown.
How is the condition diagnosed?
A healthcare provider may suspect this condition after taking a person’s health history and doing a physical exam. The provider may order a variety of tests, including:
ECG, or heart tracing.
Chest x-ray
Echocardiogram, an imaging test that uses ultrasound waves to look at blood flow and pressures with the heart.
Blood cultures to check for infection in the blood.
Biospy of the heart muscle, which involves taking a small piece of heart muscle for testing in the lab.
What are the long term effects of the condition?
Often this condition is silent, causing few or no symptoms, and goes away on its own. Most people recover completely. Rarely, a person may develop permanent congestive heart failure, arrhythmias, and damage to the heart muscle, known as cardiomyopathy.
What are the treatments of the condition?
If an infection can be identified, antibiotics are sometimes helpful. If a biopsy of the heart muscle shows active inflammation, corticosteroids or other anti-inflammatory medications maybe useful.
A variety of medications can be used to treat the complications of this condition, such as congestive heart failure and arrhythmias. In severe cases, a person may need a heart transplant to survive.
Constructive pericarditis
The sac of fibrous tissues that surrounds the heart is called the pericardium. Constrictive pericarditis results from scarring of this lining. The scar encases the heart and may limit is ability to pump blood. The pericardium is a thin sac that covers the heart. As it heals from an infection or injury, a scar may form. The pericardium becomes rigid due to the scarring. This may restrict the filling of the heart with blood and cause other health problems. This condition may cause:
· Weakness
· Fatigue
· Weight Loss
· Loss of appetite
· Shortness of breath, especially with activity or when lying flat on the back.
· Swelling in the legs. Swollen neck veins.
· Abdominal distress and tenderness, especially in the right upper part of the abdomen.
· Swelling of the abdomen due to fluid accumulation, known as ascites.
· Heart murmurs, or abnormal sounds.
What are the causes and risks of the condition?
While the cause of this condition is often not known, the scarring may be due to:
· Infections, such as tuberculosis.
· Tumors or cancer
· Injury
· Radiation therapy
· Autoimmune disease, which causes a person’s immune system to attack his or her own body.
What can be done to prevent the condition?
In most cases, nothing can be done to prevent this condition. Early treatment for some infections, cancers, and autoimmune diseases may help prevent some cases.
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This article is written by Dr. Bimal Chhajer (Heart Specialist in Delhi)
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