One San Felipe Doctor's Opinion
A retired physician talks about medicine.

San Felipe, Baja, Mexico
Chest Pain: Is It your Heart or Not?

This question is asked numerous times daily by both lay and medical personnel and the answer is not always as straightforward as you may think. The medical literature describes “classic” heart-related chest pain (or angina) as an aching, burning sensation in the mid-chest and/or left upper arm or jaw brought on by exercise and relieved with rest. Unfortunately, as in other areas of medicine, many people, especially women, have heart-related chest pain that is not classic or typical. However, certain factors can help guide you through this quandary. The first key to understanding your situation is to define your risk status for heart disease. These risk factors are as follows:

  • Smoking
  • Obesity
  • Personal history of heart attack, stroke, known blockages in the coronary or other blood vessels.
  • Personal history of high blood pressure
  • Male 40 or older or female of 50 or older
  • Family history of heart disease in a first degree relative or numerous members of extended family
  • Elevated cholesterol and triglyceride levels in certain people.

Obviously the more risk factors you have, the greater the chance that your chest pain is heart-related. Historical factors can be helpful in assessing the cause of chest pain. Pain aggravated by exertion and relieved with rest is suspicious. Heart related chest pain (especially in women), may occur without exertion, and would be of concern in a person with numerous risk factors.

Other aggravating and relieving factors can be helpful in differentiating the cause of pain. Chest pain occurring just after a meal can be cardiac, however this is less likely if relieved with antacids or belching. The location of pain is of some help. Right-sided chest pain is generally not heart related. The type of pain may be useful in differentiating a cardiac cause of pain from a non-cardiac cause. Superficial pain that worsens with deep breathing and can be reproduced by pressing on the chest is unlikely to be heart-related. If the pain does not abate within an hour, you should seek urgent medical attention. Remember, even medical professionals have great difficulty in differentiating heart-related chest pain form non-cardiac chest pain. If you do have heart-related chest pain, time is of essence—the sooner you are diagnosed, the more quickly emergency treatment can be initiated. If you have a prior history of heart disease, you could take a baby aspirin (81 mg), but no more until you have sought medical attention. A bleeding ulcer can cause chest pain as well, and aspirin certainly has the potential to be harmful in that situation.

If your chest pain is not heart-related, further, less-urgent testing can be done to determine the cause. Other causes of non-cardiac chest pain include gastrointestinal conditions such as heartburn and ulcers, pulmonary conditions such as bronchitis and pneumonia, and musculoskeletal conditions such as a pulled muscle or inflamed cartilage in the chest or arm area. The bottom line is if in doubt, check it out. A round-trip ticket back home with a non-cardiac chest pain diagnosis is certainly preferable to a one-way ticket to the hospital with a delayed diagnosis of cardiac chest pain.

Anonymous physician

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