Verified By Apollo Hospitals September 17, 2024
When we hear the word emergency, one of the most striking associations we tend to make is with chest pain and heart attacks. However all chest pain is not due to heart attacks and one needs to be aware of what the different kinds of chest pain are – as well as what the possible consequences are.
Though chest pain is one of the cardinal manifestations of cardiac disease, it is important to recognize that it may originate not only from the heart but also from other structures within the thorax (chest cavity) such as the aorta and pulmonary artery, lungs, pleura, mediastinum, esophagus, diaphragm, skin, muscles, carvicodorsal spine, costochondral junction, breasts, sensory nerves, spinal cord, stomach, duodenum, pancreas and gall bladder.
When evaluating chest pain, it is most important to obtain a proper history, delving into details of its location, spread (radiation), character, aggravating and relieving factors, time, duration & frequency, recurrence pattern, setting and associated symptoms.
It is also important to observe the patient’s gestures. Clenching the first in front of the chest when describing the pain is a strong indication of cardiac origin of pain.
The chest pain of cardiac ischemia and an impending heart attack is described variously as pressing, squeezing, strangling, constrictive, bursting, or burning. “Band across chest”,
“Weight in center of chest” is another description.
The pain normally spreads from the centre of the chest to the shoulders, the arms (especially the inner aspect of the left arm) neck, jaws and teeth. Emotions / effort / heavy meals / stress may precipitate it. The pain is normally relieved by rest. Such pain lasting for longer than 20 minutes may imply significant ischemia leading to a heart attack. A Nitroglycerine tablet kept under the tongue relieves the pain.
Not all cardiac pains have descriptions as above. There are some symptoms called ‘Anginal equivalents’ such as shortness of breath, discomfort localized to left arm, lower jaw, teeth (with people seeking a Dental opinion!) neck belching, indigestion, sweating or dizziness.
Tumulty has aptly likened obtaining a meaningful clinical history to playing a game of Chess: “The patient makes a statement and based upon its content, and mode of expression, the Physician asks a counter question. One answer stimulates yet another question until the clinician is convinced that he understands precisely all of the circumstances of the patient’s illness.”
So when chest pain occurs, the best option is to seek medical help immediately and be cooperative and clear in describing the symptoms to your doctor. Not all chest pain is related to the heart. But remember – never ignore chest pain and always seek medical help. It could save your life.
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