Chest Pain

WHEN TO SEE YOUR DOCTOR

* See your doctor for any chest pain.

* Consider it a medical emergency if the pain is severe and radiates from the chest to the shoulders, neck, arms or jaw or is accompanied by dizziness, fainting, sweating, nausea or breathlessness.

What Your Symptom Is Telling You

Suddenly, you're having chest pains, and a wave of fear overtakes you. You've seen enough episodes of "General Hospital," "St. Elsewhere" and "Marcus Welby, M.D." to know what that means: the Big One.

Before you go into a panic, consider one thing first: While TV chest pains are always heart attacks, the causes of real life chest pains are not always so dramatic.

"Though we must always consider the worst, there are over 50 possible causes of chest pain, many of which have nothing to do with the heart and are not at all life threatening," says Charles E. Chambers, M.D., assistant professor of medicine at Pennsylvania State University and a cardiologist at the Milton S. Hershey Medical Cen-ter in Hershey. "In general, a sudden jab of pain, a dull, lingering ache, a burning feeling or a sensation that changes when you shift your upper body is not cause for panic. In those instances, doctors can usually rule out a heart disease problem or one that needs immediate emergency treatment."

How can you recognize what are probably true heart-related pains? Picture this: You're walking or exercising and suddenly you experience a pressure, tightness or squeezing directly behind or slightly to the left of your breastbone, possibly radiating up and down your arms, back, neck and jaw. You sit down, catch your breath and the discomfort subsides in 5 to 15 minutes. Heart attack? More likely it's what cardiologists call angina pectoris or just plain angina. (If you experience an episode like this, don't assume it is angina; see your doctor for a diagnosis.) With angina, fatty deposits accumulate inside the coronary arteries, narrowing the channels, slowing the blood flow to the heart muscle and depriving it of much-needed oxygen.

"Angina typically occurs during exertion or moments of excitement when the heart works harder and requires more oxygen-rich blood," says Marvin Moser, M.D., clinical professor of medicine at the Yale University School of Medicine and author of Week by Week to a Strong Heart. "It's the heart's way of signaling that it needs more oxygen, just as your calf muscle does when you develop a cramp."

A number of lifestyle factors, such as smoking, stress and lack of exercise, can make the coronary blockage worse and, therefore, makes the potential for pain greater.

Angina is not a medical emergency, but it may be a warning of one to come. Suppose one of those arteries is severely narrowed or a blood clot completely cuts off blood supply to a portion of the heart. A portion of the heart muscle can actually die.

When that happens, it is a heart attack, and in most cases the heart will let you know in no uncertain terms. The resulting pain can resemble angina, but typically lasts longer, is more severe and is often accompanied by dizziness, nausea, shortness of breath and sweating. When these symptoms occur, you don't sit around hoping that it will go away. You get immediate emergency medical treatment to prevent further destruction of heart tissue.

Heart pain isn't always coronary artery disease, however. Consider pericarditis, an inflammation of the tissue sac surrounding the heart. It's usually caused by a virus. This common condition can produce a constant sharp pain that worsens with each breath or when you lie down. Rips in the heart's artery or diseases of the heart's valves can lead to a wide variety of chest pain symptoms, and all are usually different from those of angina or heart attacks.

There are also chest pains that don't originate in the heart. "A great number of them are stress related," says John Cantwell, M.D., director of preventive medicine and cardiac rehabilitation at Georgia Baptist Hospital in Atlanta. "Anxiety attacks and stress can produce tension in the chest muscles or cause the heart to beat a bit erratically. People who suffer from anxiety often hyperventilate, and their rapid breathing can lead to chest discomfort in addition to tingling and numbness of the lips and extremities."

For many people, the pain can be traced to relatively benign gastrointestinal causes like gas, heartburn, hiatal hernia (which is actually a small portion of the stomach that has slipped through an opening in the diaphragm) or the regurgitation of stomach acid. Usually this kind of pain is in the lower chest and produces sensations ranging from burning to a dull ache.

Any sharpness that worsens when you inhale could be a sign of pleurisy, an inflammation of the lining of the lungs. Or it could mean pneumonia or some other lung condition. Another possibility is any kind of injury—a strained chest muscle or cartilage or bruised or broken ribs.

Symptom Relief

Chest pain does not always mean a visit to the emergency room. Still, when it occurs, be safe and let a doctor check it out. Here's how you and your doctor can keep angina and other chest pains under control.

Make an immediate pit stop. "Don't try to walk off a sudden chest pain," says Dr. Cantwell. "If the pain is from angina, it should go away with a few minutes of rest. If it doesn't, or if it gets worse, get to a doctor."

Blast the pain with nitro. A prescription nitroglycerin tablet dissolved under the tongue safely relieves most angina attacks in minutes by acting as a vasodilator. That means it causes the blood vessels to relax so more oxygen-rich blood can pass through. "Today you can get nitroglycerin in a skin patch, but many people find that the patches lose their effectiveness over the long term. There are long-acting tablets available that can be taken two to four times a day," says Dr. Moser.

Ask your doctor about medications. Other vasodilating medications for angina and other heart conditions include calcium channel blockers (nifedipine or diltiazem, for example). They increase the heart's oxygen supply. Beta blocker drugs (atenolol, propranolol) decrease the heart's need for oxygen by reducing the heart's workload.

Take aspirin. Aspirin can be a big help for injury-related pain as well as the inflammation that comes with pericarditis, says Dr. Moser. Also, people with angina may help lower their risk of heart attack by taking aspirin every day (with their physician's consent). A baby aspirin or half of a full aspirin is all that is necessary, he says. And if someone is suffering a heart attack, swallowing an aspirin on the way to the hospital may help to prevent clotting, says Dr. Moser.

Settle your stomach. Take an antacid tablet or a spoonful of Maalox, gulp some water, eat a cracker—anything to cool down your raging heartburn. And avoid those foods that tend to anger your gastrointestinal system.

Let one rip. Take a big gulp of club soda, open your mouth and let out a loud belch. It may be rude, but if the pain is from gas or a large meal, you'll feel a lot better than if you mind your manners. (For more tips on getting rid of gas, see page 204.)

Prop yourself up. Some chest pain, like that caused by pericarditis, comes on while lying down. Dr. Chambers recommends propping yourself up with pillows to prevent and alleviate this discomfort.

Uncoil yourself. Loosen up. Relax. Meditate. Take a vacation. Or seek professional counseling. Stress and anxiety buildup may create chest pain, which only makes you more stressed and anxious.

Avoid activities that bring on the pain. Although exercise is important, angina pain may be more prevalent with certain aerobic activities like running or shoveling snow. Find less strenuous workouts like walking or swimming to keep yourself fit.

Kick the habit. Smoking constricts the blood vessels and makes the heart work harder. People who have angina often see a marked reduction in chest pains within weeks of quitting.

Imbibe with caution. One too many highballs can go to your heart as well as your head. Excessive alcohol consumption produces many heart irregularities, including chest pains.

Curtail your coffee consumption. Ditto for colas and other beverages containing caffeine or other stimulants.

See also Heartburn; Muscle Pain; Stomach Cramps