All kinds of chest pain and we see this every day.
It's one of the biggest features that enter the emergency department and one of most frequent
complaints that we have from people coming to get a cardiology consultation.
It occurs from various issues.
It can occur certainly from cardiac pain but it can also occur from muscular skeletal discomfort
from prior injury.
It can be associated with pulled muscles or sore muscles from coughing.
Sometimes coughs can be violent enough, in the flu season for instance with a bad bronchitis
they can actually cause costochondritis, which is pain at the junction of the rib and the
cartilaginous portion of the rib or sternum.
The most important characteristic of cardiac pain is the fact that it occurs with exertion
and a crescendo manner and then goes away in a decrescendo manner when the exertion
stops.
It tends to get worse over time.
Over a space of a week or two it will get worse.
The pain of a myocardial infarction or a heart attack tends to be much more severe than that
but it still has the crescendo flavor to it.
It tends to be more oppressive, it may be associated with shortness of breath or sweating
and in general an impending feeling of doom.
The best strategy is to actually call your physician and talk about the pain with them.
Certainly if the pain is fairly sudden, not horribly severe and has a pleuritic nature
to it, in other words, it decreases with respiration and so forth; there is little reason to run
off to an emergency room.
If it is associated with some other symptom such as sweating, shortness of breath or it
gets worse when you lie down then sure that needs to be presented to an emergency room.
Well that is a tough one; one can have cardiac discomfort that seems very much like esophageal
reflux.
There is a burning quality to cardiac pain sometimes.
Reflux can come on in a crescendo manner; it gets worse when you lie down.
So that's sometimes a little bit confusing and requires further evaluation.
It's very common.
If, on the other hand, it promptly goes away when a person takes an antacid that would
be very non-typical for cardiac pain.
Sometimes people have tried these remedies and sometimes they have not.
Any discomfort that has that crescendo flavor to it, vague in location, truly uncomfortable,
gets worse when they lie down, unassociated with changes in respiration and especially
if they have risk factors of high blood pressure, high cholesterol, family history, a prior
cardiac event, those people ought to be a little more willing to come and discuss it
with a professional.
We see people in their early 30's that have coronary artery disease.
It's vastly more uncommon than it is to see them in their 50's and 60's have events.
Nonetheless it does occur.
In people with any risk in their family I think they ought to at least get a blood test,
check their blood pressure and perhaps do that on a yearly basis or every other year
if it's a lower risk.
Certainly diabetics and younger people who have already been diagnosed with hypertension
they should definitely be under the care of a physician.