Chest pain can have a number of different causes. Pain from the heart is usually due to narrowed arteries and is experienced as a dull ache across the upper chest, sometimes spreading to the arms or jaw. It usually occurs during exercise or emotion and is relieved by rest.
Sometimes chest pain is not due to a problem with the arteries supplying the heart. It can also occur from inflammation of the lining of the heart (pericardium) but also from problems with the lungs, the oesophagus (gullet), and rib cage. Reaching the correct diagnosis required expert evaluation by your doctor to ask detailed questions about the pain and select the correct investigations.
After carefully reviewing your medical history and details of your chest pain, your cardiologist will suggest appropriate investigations. Patients usually need an electrocardiogram (ECG) to look for any evidence of previous heart attacks, and an echocardiogram (ultrasound) to check the heart function. You may also need blood tests if there is concern you may be anaemic or have kidney problems.
Many patients with chest pain will undergo a CT coronary angiogram (CTCA) which identifies narrowings in the blood vessels and is a useful “rule out” test. Patients with a normal CT coronary angiogram have a very good prognosis with a low risk of heart attack over the next ten years.
A stress echocardiogram or stress perfusion cardiac MRI are alternatives. If the symptoms are highly suggestive of angina and there is a high likelihood of narrowings, patients may proceed straight to an invasive coronary angiogram.
If you are diagnosed with angina, then you are likely to be recommended to take a statin to reduce any further build up of disease in the arteries and perhaps aspirin. There are a number of different tablets that can be taken to reduce angina including beta-blockers and nitrates. You may also be offered a cardiac rehabilitation programme.
Sometimes an angioplasty (stent insertion) may be required to improve symptoms. If there are narrowings in many different places, or the narrowings are in places that are difficult to treat using a stent, then coronary artery bypass surgery (CABG) may be considered.
Chest pain has a number of causes and requires careful evaluation to ensure that important diagnoses are not missed. Our cardiologists are available for consultation on any day of the week and weekends as well.
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