Specialist advice on managing chest pain: when an echocardiogram is essential

Chest pain can be caused by many different conditions and issues, which is why a thorough diagnosis is important in order to find the best treatment for the patient. In this article, consultant cardiologist Dr Sveeta Badiani explains how an echocardiogram can reveal the cause of chest pain.

What causes chest pain?

There are a variety of causes of chest pain, including from the heart, lung or gastro-intestinal tract. Chest pain as it relates to the heart is commonly caused by angina, a condition where the blood flow to the heart is restricted due to a blockage or narrowing in the blood vessels – likely due to high cholesterol, high blood pressure, smoking and a family history of heart disease. The pain, caused by the heart straining to maintain adequate blood flow, may feel like a heavy, pressure like or squeezing sensation and usually occurs on exertion and is relieved with rest. In contrast, pericarditis is sharp, stabbing pain that gets worse on lying down or breathing in. It is caused by an inflammation of heart tissue that can originate with infection or autoimmune diseases.

For chest pain that has long been troubling a patient since childhood, they may have a congenital heart condition that they were born with. Cardiomyopathy, in which the heart muscles thicken and stiffness, can also be a cause of chest pain.

Chest pain in a suddenly occurring but prolonged episode is likely to indicate a heart attack, caused by extreme obstruction in the heart’s arteries like a blood clot. Heart attacks require immediate attention. For those who have experienced a heart attack previously and recovered, their hearts may still have leftover damage which can cause them pain.

How can echocardiograms help diagnose the cause of chest pain?

An echocardiogram is an ultrasound test that checks the structure and function of your heart and can diagnose a range of conditions. It is essentially a graphic outline of your heart’s movement. There are several types of echo tests, including transthoracic, stress, and transoesophageal.

The test uses ultrasound (high-frequency sound waves) from a hand-held probe with gel, placed on your chest to take pictures of your heart’s valves and chambers. The soundwaves are transmitted through the gel and travel into the chest, where they bounce around and back to the probe as echoes. The test incorporates a technique called Doppler ultrasound to evaluate the blood flow across the heart valves.

A stress echocardiogram is an ultrasound of the heart before and after exercise. It assesses the heart function when the heart rate is fast. The exercise may be performed on a treadmill or a bicycle. There are other ways of performing a stress echocardiogram for those that are unable to exercise. A medication called dobutamine can increase the heart rate. A transoesophageal echocardiogram is where the ultrasound probe is inserted into the body down the oesophagus (food pipe).

How can chest pain be managed?

Identifying the cause of chest pain is crucial. Aside from typical lifestyle recommendations like a healthy diet with fewer saturated fats and partaking in regular exercise, doctors may also recommend medicinal interventions, such as medications:

• Nitroglycerin and other artery relaxers to facilitate easier blood flow
• Aspirin, a type of nonsteroidal anti-inflammatory drug used to treat pain, and inflammation, and thins the blood.
• Thrombolytics, which are administered to those with blood clots and heart attacks to dissolve clots.

For more urgent or serious cases, surgery may be necessary, such as angioplasty and coronary artery bypass grafting, but the type of procedure will depend on the issue.

If you are experiencing chest pain and would like to consult with Dr Badiani, you can do so via her Top Doctors profile.