Pain in The Chest

When a patient complains of pain in the chest, angina is naturally one of the possibilities the doctor considers. Once thought to be a crippling heart disease, angina can often be managed satisfactorily with treatments that offer a new way of life for many people.

The trouble occurs when narrowed blood vessels can not supply enough oxygen-rich blood to the heart muscle when it is needed most. Usually it happens during exertion, when the heart must pump more vigorously to send fresh blood around the body to the muscles during exercise.

The heart – very sensitive to a lack of oxygen – soon signals its distress and the resulting pain may be felt in different areas and in different ways.

Attacks of pain or oppression which occur anywhere in the torso, especially in the region of the upper or middle sternum (breastbone), precipitated by effort or emotion and persisting for a few minutes are virtually diagnostic of angina.

Attacks that do not have this precise relationship to effort or emotion are probably due to some less serious cause.

The discomfort is described in many different ways by patients. Some describe it as a feeling of constriction and tightness, starting pretty soon after activity. The more strenuous the exercise, the sooner and more intense the pain is likely to be.

Another common and often unsuspected cause is exposure to the cold. That’s why many people have attacks during winter. Emotional stresses and tensions are also well known as starters of an angina attack.

Stresses and tensions at work may sometimes bring on a bout in susceptible persons. That may be a reason why “overwork” is sometimes incriminated. It is also claimed that this kind of heavy pressure can bring on a life-endangering heart attack.

In about 90 percent of cases, myocardial ischemia is the cause. This simply means that the heart muscle is not getting sufficient oxygen to do its job properly. But some other heart diseases occasionally can produce angina, too.

As well, other factors bring on the trouble.

  • anemia
  • thyrotoxicosis (an over active thyroid gland)
  • obesity
  • smoking
  • chronic gall bladder disease
  • duodenal ulcers
  • cervical spondylosis (inflamed neck joints)
  • anxiety

Some of these are easy to pick up; others are more elusive. Many cases may be self-inflicted. For example, one of the most obvious troublemakers is cigarette smoking. Most doctors agree this has an adverse effect on the body.

The same may be said about overweight. When so much extra energy is needed to carry the weight, the heart has to work much harder. In both cases, the heart has an enormous, extra load.

Angina can be milder in some people, more serious in others.

The picture is unpredictable. For many, suitable medication enables them to live within their limits of activity and carry on a relatively normal life.

The doctor would be especially troubled to see angina of recent onset which progresses rapidly, indicating that the basic cause may be deteriorating, so needing urgent treatment. An attack that comes on while the person is at rest can also be difficult, for it means that even without activity, the heart is not getting adequate supplies of oxygen.

Sometimes it happens that people can’t seem to find a medical program that suits them. In such cases, bypass surgery can offer fresh hope.

For the most fortunate, the complaint seems to disappear. In 15 to 30 percent of patients, angina subsides completely and may not return.

The most important thing a person with recurring chest pains must do is seek medical advice. The sooner this is done the better.

Often the medical history is enough to give the doctor a very good idea of the diagnosis. However, certain tests pinpoint the trouble and give an idea of its extent.

Management at first consists of trying to eliminate any of the predisposing factors, such as:

  • trying to lessen anxiety
  • cutting down on smoking
  • trying to lose weight
  • treating the basic cause

If these can be eliminated then the risks are greatly reduced. Medication has taken a major step forward in recent times, as new forms of therapy have become available.

With the advent of the family of drugs called the beta-blockers, a major milestone occurred. This greatly reduces the severity and frequency of angina attacks, and is currently extremely popular with doctors. Side effects are few.

Today, a huge number of variants to the original one, so that a tailor-made regimen is available for nearly all.

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