Every Chest Pain Is Not Heart Attack

Angina pectoris

Due to atherosclerosis [narrowing of coronary arteries] lesser blood flows through coronary arteries hence less oxygen is supply to heart muscles. The sensation of pain is caused by the production and collection of unoxidised metabolic products in the heart muscles which in turn stimulate the numerous sensory nerves surrounding coronary arteries. From there it is conducted via nervous pathways to the area where it is felt as chest pain or Angina pectoris [commonly known as angina].

Every Chest Pain Is Not Heart Attack

• The pain of angina pectoris starts after physical exertion or emotional outburst in the region of behind sternum [commonly known as the breastbone]. Dull pain which radiates to the left arm towards the little finger. This is relieved soon after taking rest and nitrite tablets. Pain is transitory and lasting not less than a minute and generally not more than 15 minutes. Pain associated with heart attack is more prolonged and usually not initiated by any physical exertion. It may be accompanied by Tachycardia [rapid heartbeat], sweating, breathlessness, unconscious, fall down, most probably  low B.P. This type of pain lasts for several hours and relieved after taking specific injections and medicines.
• Sprain and strain in the muscles and ligament about the lower neck and upper thoracic spine is also responsible for unrecognised pain over the region of heart and left arm. Stiff neck is the obvious symptom.
• Osteoarthritis of upper thoracic spine or lesions of spinal cord or nerve endings generates shooting pain in the heart region. This pain occurs in band-like zones covering front and back of chest corresponding to the problematic nerve segment.
• Compression of nerves by a cervical rib may also causes pain in  left arm and heart region . This kind type of pain is sharp, aching and generally radiated to 4^th and 5^th finger with sensation of numbness and tingling.
• Prolonged work and fatigue also induces discomfort behind sternum, nothing to do with angina pectoris.
• Pain due to an inflammation present at the junction of a rib with its cartilage on either side of upper portion of sternum, also known as Tietze's syndrome. This type of pain is continuous and increases in intensity by apply pressure over the inflamed area, there may be swelling over that region.
• Sometimes blockage in artery of lungs, cough, spitting blood in sputum, Pulmonary embolism [when one or more pulmonary arteries in lungs become blocked] may look like a heart attack.
• Sometimes specific abdominal conditions generate severe chest pain. Indigestion, stomach peptic ulcers, inflammation or stones in gall-bladder, pancreatitis, acute abdominal obstruction or appendicitis may stimulate chest pain just below sternum. Generally this type of pain occurs 1-4 hours after meal and relieved by taking alkalis and cold milk.
• Inflammation of outer covering of heart pericardium or pericarditis may induce the symptoms of chest pain and fever.
• Inflammation of pancreas also induces the symptom of chest pain, radiate towards front and back and  misunderstood as heart attack.
• Cardiac Neurosis is a medical condition frequent in neurotic person involves excessive fatigability, palpitation, diffuse pains in different parts of body, feeling of stress , anxiety and breathlessness. This type of condition is associated with mind and does not necessarily caused by actual heart diseases.

Diagnosis of heart attack

• Chest pain
• Shock
• Pulmonary oedema
• Fast pulse, tooth pain, numbness of left or both wrists.

Signs detected by doctors

• Chest pain
• Restless
• Vomiting
• Sweating
• Hand and feet are cold
• Pale look
• Shallow breath
• Tachycardia --- heart beats faster than 100-110 beats/minute. If it is more than 150 beats/minute or less than 30 beats/minute indicates damage to the area of pulse originating region.
• Low B.P. --- as a rule heart attack causes a fall in B.P. It may drop down as 90 of upper limit, lower than 70 means state of shock.
• Fever --- within 24 to 48 hours of heart attack there is moderate raise in temperature may persist up to 2-6 days.
• Stethoscope may reveal some extra sound coming from inside chest; heart sounds are normal, faint and low- pitched.

Tests to differentiate heart attack pain from other pain

• E.C.G
• Blood test, for W.B.C, polymorphonuclear %, E.S.R, blood enzymes
• X-ray of chest, bones, gall bladder
• Complete neurological examination

BY
GEETA JHA
INDIA