Men's Health

Chest Pain

Written by Mark Abell

Chest Pain. We hear about it a great deal. Many people either know friends who have been to an emergency room with complaints of chest pain, or have been there themselves. It's no joking matter, even though there are a lot of causes of chest pain other than the heart. Before some things are done, however, and one is assured that the heart is not the cause of the pain, a paramount interest in the reasons for having the pain becomes the very reason we seek medical attention. So, what about chest pain? What are we dealing with?

The first and foremost (and probably most important) reason for the development of "chest pain" is a lack of oxygen to the heart, which is called ischemia. When an organ, such as the heart, gets into some sort of trouble with oxygen, there are certain changes going on - changes that can lead to yet more serious problems. The chest pain, in most instances, is merely a warning sign. Your body is trying to tell you something is amiss. Let's dive a little deeper.

The heart is a muscle; it is also a pump. It's function is to pump oxygen rich blood through the rest of the body. The heart is always working, doing its well crafted task of taking blood from the venous system, pumping it through the lungs, and then out into the aorta, or the arterial system. The blood then is used as a tool to supply the body with oxygen and then remove what is metabolic waste (some of which is carbon dioxide). That's a difficult job in and of itself, folks, but let something go wrong and the heart will start to fail. That's when the pain develops, and that's when the warning signs occur (although there could have been previous signs, such as shortness of breath, feeling very tired, etc., which were ignored).

The heart receives its own blood from a system of vessels called the coronary arteries, which branch off from the aorta. These vessels deliver blood to the heart during the relaxation phase, called "systole". Usually, the coronary arteries do well; they remain open (or patent), and have no problem delivering the blood to the tissue of the heart. However, there are a number of problems which could develop, such as high cholesterol, stress, diabetes, or hypertension (high blood pressure); these problems, and many others, can cause blockage of the coronary arteries (as in cholesterol), leaving some of the heart with a shortage or complete lack of oxygen. Hypertension can lead to atherosclerosis, or hardening of the arteries (the arteries need to remain flexible in order to function properly) and diabetes can lead to "silent" heart attacks. There are many others, but the point is that the heart muscle is without its needed oxygen.

When chest pain develops due to "ischemia", which is called angina, it's not the heart that is hurting, but other nerve fibers that "innervate" or connect to the heart, which also innervate with other organs or tissue in the body. For instance, a person complaining of left arm pain could be suffering from cardiac (heart) ischemia because the same nerve fibers that "innervate" or connect to that area of the body also supply nerve bundles to the heart. The impending ischemia of the heart leads to a "crushing" pain felt in the substernal area of the chest wall, with the "patient" holding a fist to the front of the chest, bending over slightly (Levine's sign). There is also (not always) complaints of shortness of breath (dyspnea) and sweating (diaphoresis). Sometimes, the patient vomits or has a feeling of nausea. In the more severe cases (as in a true "heart attack, or myocardial infarction), there is a feeling of doom, and the patient reports that he (or she) feels as if there "is an elephant sitting on my chest".

What can we do about chest pain? Well, the issue is (when dealing with the heart) a lack of oxygen, so we need something that will open or dilate the vessels to the heart, which, as in the acute phase, is what nitroglycerin does. If anyone has ever taken a tablet of nitroglycerin for chest pain, you might remember a dull headache afterwards; that's due to the fact that the medicine dilates vessels in the brain also (as well as other areas, which leads to a reduction in the blood pressure) - more blood in the brain leads to a headache. It will go away, but the heart is saved.

There are other reasons for chest pain, but one should not try to self-diagnose the problem, particularly if there is a family history of chest pain and you have been treated for other medical problems. There's no room for guessing. Get to the emergency room. An electrocardiogram (EKG) as well as blood work will let the physician know the reason for the pain. A stomach problem, such as hiatal hernia or an ulcer can easily mimic chest pain that feels like a heart attack. Sometimes, as with a cold or bronchitis, prolonged coughing can cause stress to the chest wall, which causes irritation of the muscles and nerves; however, chest pain is the main concern. Even a virus, as speculated to be the culprit with "costrachondritis" (inflammation of the chest wall) has been blamed for "chest pain". And, then there is simply anxiety. But, don't let this fool you. Chest pain needs to be checked out by a trained professional. Remember, it could be a warning sign of further problems in the future, or another undiagnosed problem. Listen to your body. It's the only one you have, and you cannot trade it in for a newer model - at least not yet.

For all the internet surfers, check out the following URL's concerning the topic of chest pain; they are very informative. There are lots more - simply search "chest pain" or "heart attack".

What does heart-related pain feel like?

Diagnostic dilemma of Chest Pain

Chest Pain in Emergency Service

Medicine-Net - Chest Pain of Angina

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