Chest pain can be caused by a variety of reasons, including things like angina, heart attack,
but we also know palpitations can also bring on chest pains.
These are the worrying causes, but there are other causes as well.
Things like acid reflux can precipitate chest pain.
The chest wall itself can cause pain.
So, we know that the chest is made up of the breast bone and also muscles into space between
the ribs.
So, the pain can be coming from any of those sources.
Chest pain can also be caused by the lungs as well.
So that sort of chest pain is usually pain that is exacerbated when someone breathes
in or out.
But anxiety is another common cause that we see in patients as well.
Chest pain is usually quite a worrying sign for patients.
If you experience central chest pain, this is something that you should certainly be
concerned about.
Things that you need to be looking out for, or the sort of characteristics of the chest
pain, if the chest pain comes on in the centre of the chest, comes on suddenly and is made
worse with exertion, then this might be indicative of pain of angina.
And if this is the case, then this is certainly something that you should discuss with your
general practitioner.
If the pain however persists, and is associated with breathlessness, sweating, a clammy sensation,
then you have to be concerned that this might be pain being caused by a heart attack.
And in that case, I would always recommend that you let your loved ones know at home
and also ask somebody or maybe yourself to dial 999 and call for an ambulance.
Pain of a heart attack or myocardial infarction as doctors call it, is pain that comes on
suddenly in the centre of the chest.
Patients usually describe a tight sensation, a band-like feeling in the chest.
The pain usually spreads up into the jawline.
It can occasionally go down into the left arm.
Patients have also described pain radiating or spreading through into the back or into
the right arm.
The worrying feature of the pain is that the pain persists.
So, it can go on for 20, 30, 40 minutes.
And if that's the case, then this is a pain that needs to be taken seriously.
Patients usually complain of being short of breath at the same time.
They may feel symptoms of sweatiness or clamminess.
They may feel light-headed or dizzy.
And if this is the case, then I normally advise that patients dial 999 and ask for an ambulance
to attend urgently, because they may be experiencing a heart attack and they will need to be transferred
to a hospital for rapid treatment for this.
Usually what will happen is that your GP will refer you to a specialist depending on what
your GP thinks is the most likely cause of the chest pain.
If you are referred through to a cardiologist, then we will carry out further investigations
to make sure that the chest pain that you're having is not a pain of angina.
Some of the tests that we would normally undertake would include stress test.
And this is a test that is designed to see what your exercise capacity is like, and whether
or not exercise will bring on some of the symptoms of angina.
So the classical pain of angina is usually a pain in the centre of the chest which is
made worse with exertion and eased by rest.
So, having a patient exercise can bring out some of these symptoms and help with a diagnosis.
Other investigations that we might carry out would include a CT scan of the heart arteries.
This allows us to have a look to see if there are any potential blockages in the heart artery
supplying the heart muscle.
And we may even consider doing a test called an angiogram which is an invasive test but
allows us to look directly at the heart arteries to determine whether or not there are any
narrowings in the heart arteries.
If your doctor diagnoses you as having angina, there are a variety of treatments that are
available for them to administer.
The first thing that they would normally consider is medication.
There are medications which are designed to dilate or increase the blood flow to the heart
muscle.
These medications include things like Sublingual GTN Spray.
There are other treatment options available as well.
So, if you've had an angiogram done and the doctors found that there are narrowings in
the heart arteries, they may consider sending you forward for a procedure called an angioplasty.
This involves passing a small wire into the heart and dilating any narrowings with a balloon
and usually then deploying a stent which is a metal mesh work to allow blood to flow normally.
If there is extensive disease in the heart arteries, then your doctor might consider
whether you need to have a bypass done.
This is usually a procedure that's done under general anaesthesia and is an open-heart procedure.
Aside from this, there are other medications that are useful.
We know that statin therapies particularly can help stabilise any narrowings in the heart
arteries and this is a usually a treatment that would be given to you along with aspirin,
which is a blood thinner and allows the blood to flow more freely in the heart arteries.