Heart-related chest pain

Chest pain related to the heart can arise from various factors, including coronary artery disease, myocarditis, and pulmonary embolism. In his latest online article, Professor Amitava Banerjee explores the main causes of heart-related chest pain, delving into the diagnostic process, treatment options, and personalised approaches to care.

What are the main causes of heart-related chest pain?

Chest pain related to the heart can stem from various factors, primarily coronary artery disease, characterised by atherosclerosis—narrowing of heart-supplying arteries. Exertion or stress often triggers angina due to this narrowing. In more severe cases, it may lead to a heart attack, requiring urgent intervention like stent placement.

Alternatively, chest pain may result from myocarditis, an inflammation of the heart muscle, often post-viral infections. Pericarditis, inflammation of the fluid surrounding the heart, can occur following viral infections or even after a heart attack, causing chest pain.

Other potential causes involve structures near the heart, such as the aorta, which might experience rare issues like aortic dissection or swelling due to atherosclerosis or genetic factors. Urgent attention and possible surgery are necessary in such cases.

Additionally, chest pain may originate from structures like the lungs or blood vessels, leading to conditions like pulmonary embolism. Infections or musculoskeletal issues, stemming from past or recent injuries or awkward sleeping positions, can also contribute to chest pain.

To determine the cause and urgency of the situation, a comprehensive medical history, physical examination, and specific tests, including blood investigations, are crucial. This process aids in deciding appropriate and timely interventions.

How is the cause of a heart-related chest pain diagnosed?

Initially, the origin of chest pain linked to the heart is determined by meticulously gathering the patient's history, including details about the type of pain, its duration, and factors influencing its intensity. Identifying risk factors is crucial. Subsequently, a thorough examination is conducted to assess the patient adequately. Following this, appropriate tests, ranging from blood tests to specialised scans, may be required. In some cases, more invasive procedures like angiograms might be necessary, constituting a diverse array of investigative measures.

What are the main treatment options for heart-related chest pain?

The treatment for chest pain related to the heart varies based on its underlying cause. In cases of coronary artery disease, urgent intervention may involve procedures like stenting or bypass surgery. Concurrently, managing risk factors, including cholesterol control, blood thinners like aspirin, and lifestyle adjustments such as diet modification, reduced alcohol intake, and quitting smoking, is essential.

For inflammation-related causes like myocarditis, anti-inflammatory medications may be prescribed. Aortic issues may require consultation with surgeons. Respiratory causes, such as chest infections, may necessitate antibiotics. In instances of a pulmonary embolism (blood clot in the lung circulation), immediate administration of blood thinners is vital.

Regardless of the cause, pain relief is typically necessary, ranging from simple options like paracetamol to more potent medications addressing different pain classes. The treatment approach is tailored to the specific cause of heart-related chest pain.

How is treatment for heart-related chest pain tailored to each patient?

The treatment for heart-related chest pain must be tailored precisely to an individual's symptoms, investigation findings, and medical history, pinpointing the specific cause. In the case of coronary artery disease, urgent interventions like stenting or bypass surgery are required to address narrowing’s and blockages. Simultaneously, managing underlying risk factors such as cholesterol and blood pressure is crucial.

Effective management of blood glucose in individuals with diabetes contributes to long-term relief from chest pain. Medications proven to enhance survival, reduce hospitalisation, and improve overall quality of life are also prescribed. If inflammation is identified as the cause, preventive measures are implemented.

Additionally, addressing post-heart attack complications, including heart rhythm issues or heart failure, is essential. In cases where all heart-related tests yield normal results, further exploration for potential non-cardiac causes is necessary.

When is chest pain a medical emergency?

Chest pain is an emergency when it's severe and does not go away within five minutes. Despite stopping exercise or exertion, sitting down or pain relief. If the discomfort persists longer than this, immediate attention should be sought either at the local emergency department or through primary care by consulting a doctor.

Professor Amitava Banerjee is an esteemed cardiologist with more than 20 years of experience. You can schedule an appointment with Professor Banerjee on his Top Doctors profile.