Happening Issue 61 Jul, 2010

As cardiologists, it is not uncommon for us to come across patients of different age groups complaining of acute chest pain. The crucial factor is to distinguish whether the pain is related to the heart or otherwise. A heart attack can classically be defined as a severe chest pain radiating to the neck, upper limbs, jaw associated sweating, cold skin, pain of the upper back, leaden feeling in the arms, chest compression and breathlessness, or it can be a painless attack especially in the case of diabetics. Nature of the pain could be severe, crushing accompanied by tightness of the chest or constriction like a band. The clenched fist held against the breastbone is a typical sign.

What is a heart attack? It is the occlusion of one of the major blood vessels supplying blood and therefore oxygen to the heart itself. Thus, it is the  ‘air hunger’ or lack of oxygen, which kills the heart muscles. Effort can bring about transient ‘air hunger’ pain when the near occluded artery cannot meet the oxygen demand of the resting heart. This pain in medical terminology is called ‘angina’. Angina is exacerbated by hearty meals, cold weather, and emotional disturbance. Arguments and watching exciting programs on TV or sport events are typical precipitating factors. The appearance/looks is also an important indication, where typically, one looks pale, sweaty, and frightened during a heart attack.
Non-cardiac chest pain can be due to lung disease, herpes zoster, musculoskeletal problems and most commonly, gastrointestinal factor especially acute gastritis of duodenitis. This pain can also be excruciating, located just beneath the breastbone, which is also commonly known as ‘heart burn’. Tiredness, breathlessness, palpitation, swollen feet and dizzy spells are signs of heart failure more than a heart attack.

Mistakes have occurred because all types of heart problems cannot be detected by the ECG (electrocardiogram) or simply because the attending physician is not able to interpret the ECG reading as a heart attack. On the other hand reading an ECG depends upon the occlusion of the vessel involved, whether the occlusion is total or subtotal and lastly, whether the heart beat (rhythm) changes are involved or not. Palpitation as we call them is simply a rhythm problem, but it can also be a heightened awareness of the normal heartbeat due to fear or anxiety.

Chest pain worries both patients and doctors because both know that heart related pain can be life threatening, and recognizing it may make a difference to the outcome. Needless to say, it would be better to have a heart burn rather than a heart attack.

Dr. Baral is the consultant cardiologist at Ganga Lal Heart Institute & NORVIC hospital. Ph: 4436612/4437610, Mobile: 98510-53577