Heart-related chest pain and its causes

Chest pain can have various causes, but what heart conditions are linked to this symptom? Leading consultant interventional cardiologist Dr Ashan Gunarathne explains all in this comprehensive article.

What causes chest pain?

Chest pain can arise from various conditions, some of which are related to the heart, while others aren’t. Cardiovascular causes of chest pain include angina, myocardial infarction (heart attack), pericarditis and aortic dissection. Non-cardiac causes can involve the lungs, gastrointestinal tract, muscles, and bones. Identifying the source of chest pain is crucial for appropriate treatment.

What is angina?

Angina is chest pain resulting from reduced blood flow to the heart muscle, typically caused by coronary artery disease. Angina can present as a pressure, squeezing or tightness in the chest, and may radiate to the shoulders, arms, neck, jaw, or back. It often occurs during physical exertion or stress and is relieved by rest or nitro-glycerine.

How is a heart attack different from angina?

A heart attack, or myocardial infarction, occurs when a coronary artery becomes completely blocked, leading to damage of the heart muscle. Unlike angina, the pain from a heart attack is more severe, lasts longer, and is not relieved by rest. Other symptoms can include shortness of breath, sweating, nausea and light-headedness. Immediate medical attention is essential.

What diagnostic tests are used to evaluate chest pain?

To determine the cause of chest pain, a cardiologist may use several diagnostic tests, including:

• Electrocardiogram (ECG): Measures the electrical activity of the heart and can detect signs of a heart attack or other heart problems.
• Blood tests: Check for markers of heart damage, such as troponin levels.
• Chest X-ray: Evaluates the lungs, heart and chest structure.
• Echocardiogram: Uses ultrasound to create images of the heart, assessing its function and structure.
• Stress test: Monitors the heart during physical exertion, revealing issues that might not be apparent at rest.
• Coronary angiography: Involves injecting a dye into the coronary arteries to visualize blockages using X-ray imaging.

How is cardiac-related chest pain treated?

Treatment for cardiac-related chest pain depends on the underlying cause:

Angina 

Managed with lifestyle changes, medications (e.g., nitrates, beta-blockers, calcium channel blockers), and in some cases, procedures like angioplasty or coronary artery bypass surgery.

Heart attack 

Requires immediate treatment, which may include medications to dissolve clots, percutaneous coronary intervention (angioplasty with stenting), or coronary artery bypass grafting (CABG).

Pericarditis 

Inflammation of the pericardium is treated with anti-inflammatory medications and, in some cases, more specific interventions if the condition is severe.

Aortic dissection 

A medical emergency treated with blood pressure control and surgical repair.

When should you seek medical attention for chest pain?

Chest pain should always be taken seriously, especially if it's sudden, severe or accompanied by other symptoms such as shortness of breath, sweating, nausea or pain radiating to the arm, neck or jaw. Seeking prompt medical attention is crucial to rule out life-threatening conditions like a heart attack.

If you’re concerned about chest pain and being linked to a heart condition, arrange a consultation with Dr Gunarathne via his Top Doctors profile.