Chest Pain ... Don't Ignore the Warning Signs of Heart Disease (Spring 2004)
Many adults experience chest discomfort now and then. In the majority of instances, the pain is fleeting, mildly uncomfortable, and passes in a brief amount of time. As the discomfort fades, fears of an imminent heart attack tend to be dismissed as a vivid imagination and the incident is chalked up to simple indigestion or too much stress.
Even though heart burn or stress can cause chest discomfort, intermittent and mild chest pain may be a symptom of angina. In its simplest terms, angina is temporary chest pain that is brought on by a reduced blood flow to the heart muscle. GCMC Emergency Department Medical Director, Matthew Glenn, DO, comments, "Although intermittent chest pain can be caused by indigestion or anxiety, it is still an important warning sign that shouldn’t be ignored. Anyone who experiences chest pain or discomfort that "comes and goes," especially with exertion, should call their doctor or visit the emergency department. As with any medical condition, the sooner a diagnosis and treatment plan are formed, the better."
fig. 1
In regards to angina, board certified cardiologist,
David Lasorda, DO, FACP, FACC, notes "The most common cause of reduced blood flow to the heart muscle is the build up of ‘plaque’ (see figure 1) in the heart’s arteries. The arteries can be compared to a garden hose. Just as water flows through a hose, blood flows through the arteries.
When the heart’s ‘hoses’ become clogged or narrowed, blood flow to the heart muscle becomes insufficient, similar to how the flow of water is diminished in a ‘kinked’ garden hose. The decreased flow results in insufficient oxygen to the heart muscle and the body responds with warning signs such as chest pain."
Interestingly, angina symptoms in women may differ from what men experience. Men typically experience chest pain or discomfort that is brought on by exercise or exertion, and the pain usually subsides with rest. Angina in women however, may be more subtle and come and go with no obvious cause and may not improve with rest. In fact, it is not unusual for a woman to dismiss the early, and sometimes fleeting, warning signs of heart disease.
Dr. Glenn continues, "As heart disease progresses, symptoms generally worsen and may include:
- difficulty breathing
- generalized fatigue
- pain or tingling in shoulder, elbow, jaw, or arm, usually the left, simultaneous with chest pain
- shortness of breath
- nausea or vomiting
- light-headedness, dizziness and/or heavy sweating during activity.
Grove City Medical Center offers all of the diagnostic services that are necessary for the cardiologist to form an accurate diagnosis of the extent of heart disease. Dr. Lasorda notes, "The process for diagnosing the extent of heart disease usually begins with a stress test. During a stress test, the patient either exercises on a treadmill or the heart is stimulated with medication. Throughout the test, the heart’s reaction to exercise or the medication is then monitored. When the stress test indicates that there may be a problem, a cardiac catheterization is usually the next step."
fig. 2
During cardiac catheterization, a thin flexible catheter (tube-like instrument) is inserted into an artery in the groin and carefully advanced up to the heart (see figure 2). The tip of the catheter is positioned at the opening of the heart’s arteries and dye is injected. As the dye flows through the coronary arteries a type of x-ray instrument, called a fluoroscope, is used to produce images of the arteries such as in figure 3. This test is very accurate and is considered the "gold standard" for diagnosing heart disease.
Emergency Department Director, Dr. Glenn, notes, "Every week we see patients in the emergency department who may have been able to prevent a full blown heart attack. Good preventive care includes a combination of regular check ups and lifestyle choices that reduce the risk of heart disease. Incidentally, many of the lifestyle factors that can help decrease the risk of coronary artery disease also apply to reducing the risk of stroke. The five most important lifestyle factors include:
- Don’t smoke - If you currently smoke, do everything in your power to quit. It will be one of the most significant health choices you’ll ever make.
- Reduce the amount of saturated fat in your diet. Foods high in saturated fats include butter, fatty cuts of meat and processed foods that contain hydrogenated fats.
- Engage in aerobic exercise several times per week. Exercise offers enough benefits to fill a textbook and, next to quitting smoking, it is the best choice you can make to reduce your risk of heart disease.
- Diabetics MUST be very conscientious about controlling blood sugar levels.
- Monitor and control blood pressure. Uncontrolled blood pressure is like walking around with a time bomb in your pocket. Fortunately, for most people, it is the easiest of the five major risk factors to control.
In conclusion, angina attacks are a definite warning sign that the coronary arteries of the heart have narrowed and that immediate medical attention is indicated. The good news is that an early diagnosis, combined with a treatment plan that includes lifestyle changes, can greatly decrease the risk of a heart attack.
