From the Heart
Lown Group News
From the Graboys Heart Letter
Dr. Graboys was one of the founding members of the Lown Cardiovascular Center. Renowned for his
exceptional patient care and teaching, Dr. Graboys retired from practice in 2005. Below is an article that
originally appeared in the Graboys Heart Letter, a precursor to our current newslette
How to Tell if Your Chest Pain is Heart Related
by Thomas Graboys
Most of us have experienced chest pain at one time or another. For many people, chest pain is a source of fear and anxiety because it is often associated with heart disease. Fortunately, most chest pain has nothing to do with the heart. However, chest pain is not something you should ignore. It’s very important for you to understand the differences between the types of chest pain that physicians consider to be heart-related and significant, and the types of chest pain that are not.
Muscles, Joints, Lungs and “Heart Burn”
There are many structures within the chest that can produce pain. Muscle pain and tenderness in the joints are perhaps the most common causes of chest pain.
Interestingly, the lungs themselves do not have the type of nerve connections that induce pain. But the lining (pleura) around the lungs may be associated with pain if it becomes irritated or inflamed.
Another source of chest pain is the esophagus, the tube that carries food from your mouth to your stomach. Acid backing up (refluxing) from the stomach into the esophagus causes pain that can mimic a heart disorder, as can spasms of the esophagus. This pain is often called “heart burn,” even though it has nothing to do with the heart. Esophageal spasms can often be relieved by the same type of medications that relieve angina.
The chart below will help you distinguish between different types of chest pain. No matter what the chart tells you, if you have any suspicion at all that your chest pain may be heart-related, consult your physician.
What Your Physician Will Do
The most important clues to the origin of chest pain are the patient’s situation (age, sex, etc.) and other history related by the patient. When a twenty-five year old healthy athlete who has been lifting weights finds himself with chest pain, we can usually be sure it is muscular in origin. But when a male 55-year-old heavy smoker with high blood pressure, elevated cholesterol and a family history of heart disease experiences ”pressure” (not pain) in the chest when he walks up an incline or out in the cold, it’s a very different story. This man has the profile of someone with underlying coronary heart disease (“hardening” of the arteries leading to the heart).
If you have more than one of the important risk factors for heart disease (1. Family history of heart disease, 2. High blood pressure, 3. Smoking, 4. High cholesterol,6. Extremely high stress, 6. Diabetes, 7. Excess weight) your doctor is going to be much more cautious with any pain in your chest. Even if you have no risk factors, your doctor may recommend an exercise treadmill test to explore more thoroughly the possibility of a heart problem.
The Power of Exercise Testing
Exercise testing has become a common and powerful diagnostic tool over the last few decades. By checking your heart while you are exercising on a treadmill, trained cardiologists can uncover abnormalities of blood supply to the heart, decreased pumping ability, or heart rhythm disorders.
If the regular treadmill test is unsuitable or inconclusive, I recommend a “nuclear” stress test. By introducing a very small amount of a radioactive tracer element into your bloodstream when you are at peak exertion, this test can reveal areas of the heart which may not have been receiving an adequate blood supply, or it may even show areas of the heart which have been damaged even though they have shown no other symptoms. Stress echocardiography (a stress test with ultrasound pictures of the heart) is also an excellent way to look for heart artery blockages.
Take No Chances With Chest Pain
The good news is that most chest pains do not come from the heart. But if you are experiencing chest pains and you have any doubt about their cause, you should get a physician’s opinion, especially if you are older and have two or more of the risk factors for heart disease. Doctors can differentiate the types of chest pain quite readily, and, in most cases, give you the reassurance you need. In those cases where there is a heart problem, early intervention.