Chest Pain (cont.)
Angina and heart attack (myocardial infarction)
The worry for patients and healthcare providers is that any chest pain may
originate from the heart. Angina is the term given to pain that occurs because
blood vessels to the heart muscle narrow and decrease the amount of oxygen that
can be delivered to the heart itself. This can cause the classic symptoms of
chest pressure or tightness with radiation to the arm or neck associated with
shortness of breath and sweating.
Unfortunately, many people don't present with classic symptoms, and the pain
may be difficult to describe - or in some people may not even be present. Instead
of angina or typical chest pressure, their anginal equivalent (symptom they get
instead of chest pain) may be indigestion, shortness of breath, or
weakness and
malaise. Women and the elderly are at higher risk for having atypical
presentation of heart pain.
If one of the blood vessels to the heart (coronary artery) completely
occludes (becomes blocked), then the muscle it supplies blood to is at risk of dying.
This is a heart attack or myocardial infarction. In most circumstances, this
pain is more intense than routine angina, but again, there are many variations
in signs and symptoms.
The diagnosis of angina is a clinical one. After the healthcare provider
takes a careful history and assesses the potential risk factors, the diagnosis
is either reasonably pursued or else it is considered not to be present. If
angina is the potential diagnosis, further evaluation may include
electrocardiograms (EKG or ECG) and blood tests.
Cardiac enzymes can be measured in the bloodstream when heart muscle is
irritated or damaged. If these chemicals are not present, it may be reasonable
to perform imaging studies of the heart in a variety of ways depending on the patient's past history:
The purpose of making the diagnosis of angina is restore normal blood supply
to heart muscle before a heart attack occurs and permanent muscle damage occurs.
Aside from minimizing risk factors by controlling blood pressure, cholesterol,
and diabetes, and stopping smoking, medications can be used to make the heart
beat more efficiently (for example, beta blockers), to dilate blood vessels (for
example, nitroglycerin) and to make blood less likely to clot (aspirin).
An acute heart attack (myocardial infarction) is a true emergency, since
complete blockage of blood supply will cause part of the heart muscle to die and
be replaced by scar tissue. This lessens the ability of the heart to pump blood
to meet the body's needs. As well, injured heart muscle is irritable and can
cause electrical disturbances like ventricular fibrillation, a condition in
which the heart jiggles like Jello and cannot beat in a coordinated fashion.
This is the cause of sudden death in heart attack. The cause of an acute heart
attack is the rupture of a cholesterol plaque in a coronary artery. This causes
a blood clot to form and occlude the artery.
The treatment for heart attack is emergent restoration of blood supply. Two
options include use of a drug like TPA or TNK to dissolve the blood clot
(thrombolytic therapy) or emergency heart catheterization and using a balloon to
open up the blocked area (angioplasty) and keeping it open with a mesh cage
called a stent.
Coronary artery bypass surgery is considered when there is diffuse artery
disease that is not amenable to angioplasty and stenting.
For more, please read the Angina and
Heart Attack articles.
Next: Pericarditis »
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