Chest Pain

Chest pain can have any cause - from pain in the chest muscle to a heart seizure or chronic heart disease, so it should not be ignored under any circumstances.

When to seek emergency medical care?

Immediately call emergency medical care in case of a sudden sharp pain in the chest area, especially when:

You have a feeling of heavyweight, contraction, or similar;
The pain started suddenly and lasts 2-15 minutes, or more;
The pain transmits to other parts of the body, such as one or both arms, back, neck, or jaw;
You have other symptoms such as shortness of breath, nausea, vomiting, cold sweat, dizziness, or severe weakness;
You have a risk of heart disease; for example, you are a smoker or overweight, you have high blood pressure (hypertension), diabetes, high cholesterol, or a family history of heart disease.

Immediately call 112 or consult a doctor, even if the pain or discomfort was not severe, quickly weakened or gone completely, as this may be the first manifestation of dangerous heart disease.

Could it be a heart problem?

Chest pain does not always start as a result of heart problems. It may be difficult to distinguish between heart pain and pain caused by pathology of other organs. Therefore, we must always remember that it can be caused by heart pathologies, such as:

Angina - when the blood supply to the heart muscle is partially restricted due to the narrowing of the blood vessels (arteries) supplying the heart muscle;
Heart seizure - when the blood supply to a certain part of the heart muscle is suddenly entirely restricted due to the clogged blood vessels that supply the heart muscle;
Other heart conditions - e.g. aortic dissection, pericarditis, etc.

Both angina and heart seizure are different manifestations of coronary heart disease, which is based on damage to the coronary blood vessels and restriction of the supply of oxygen-rich blood to the heart muscle. These conditions can cause dull, intense, stabbing, squeezing pain in the chest area that can distribute to the arms, neck, jaw, or back. Sometimes this pain can also develop in the abdominal area. These symptoms may be accompanied by shortness of breath and nausea/vomiting.

In contrast to a heart seizure, which is an acute condition and necessarily requires urgent hospitalization in a specialized clinic, chest pain caused by angina is provoked by physical activity, various types of exercise or emotional stress. It decreases with the suspension of exercise and a few minutes of rest.

If you have been diagnosed with angina before, the pain may be alleviated by taking the prescribed medications for angina.

If the above symptoms persist for 2-15 minutes or more at rest, there is a high probability that they may be caused by a heart seizure - at this time you need immediate medical attention and hospitalization.

What kind of diagnostic tools are available?

Electrocardiography (ECG) - this method records the electrical activity of the heart. Heart problem is detected and recorded because damaged and healthy heart tissues conduct electrical impulses differently. Long-term ECG recording is often done within 24 or 48 hours.
Exercise test – during this test, the patient receives a physical load on a treadmill or ergo cycle; the electrocardiogram is recorded in parallel. The method is used to determine whether the blood flow to the heart responds to the increased demand associated with exercise. If the coronary blood vessels are narrowed, it is reflected in the electrocardiogram.
Ultrasound examination – the ultrasound is used for the examination to obtain a video image of the heart. As a result, doctors can observe the structure, contractility, and other parameters of the heart. Impaired contraction of any part of the heart often indicates occlusion of coronary vessels.
Cardiovascular angiography (coronary angiography) - a special radiotracer is introduced through a special long catheter from the artery of a limb (arm or leg) into the cardiac artery. Later, the degree of constriction (damage) of the arteries and the complete occlusion of the artery (if any) is monitored, studied, and recorded on a digital carrier.

What treatment procedures are available?

Coronary angioplasty with stenting - This procedure is similar to coronary angiography and results in the restoration of patency of the cardiac blood vessels. The manipulation is performed using a long catheter with a special cylinder installed at the end. Upon reaching the narrowed part of the blood vessel, the balloon is inflated until the blood vessel patency is restored. The balloon is removed and replaced with a so-called stent (a mesh rigid tube), which permanently remains in the damaged area of a blood vessel and prevents recurrent stenosis (narrowing). Depending on the number of constrictions, the patient may need one or more stents. There are many types of stents, many of which are made of a drug-coated metal or material. Depending on the patient's illness and the picture of coronary angiography, the doctor will advise the patient on the type of stent.
Coronary artery bypass grafting (CABG) - is a surgical intervention in which the grafted artery or vein bypasses the blocked portion of the coronary artery. For grafting, blood vessels taken from other parts of the body are used. For example, a vein from the leg or the internal thoracic artery may be used as shunts. During the bypass grafting, depending on the number of stenosis of blood vessels, the patient may need one or more shunts.

What is used for the treatment with medications?

Many medications can be used during a heart seizure, including:

Vasodilators, e.g., nitroglycerin – these little pills are taken under the tongue. They dilate the coronary vessels, reduce the heart load, and improve the blood flow in the tissues.
Anticoagulants, e.g. Aspirin, Clopidogrel.
Beta-blockers - often used to treat angina. They reduce heart rate and blood pressure, thereby reducing the heart’s need for oxygen, and even in case of damaged arteries, may improve the patient's condition.
Thrombolytic drugs – are used to dissolve an already formed blood clot; the drugs of this group can also be prescribed to prevent formation of new blood clots.
Blood thinners, e.g. Rivaroxaban - if a blood clot is formed in an artery, the drugs of this group may also be prescribed to prevent formation of new blood clots.
Cholesterol-lowering drugs, e.g., Atorvastatin, Simvastatin - high cholesterol is an essential factor in atherosclerotic damage of blood vessels. If the result cannot be achieved through healthy eating and physical activity, the doctor can prescribe daily medication that will help to normalize cholesterol levels.

In addition to the above medications, depending on the patient’s condition, other groups of drugs may be prescribed, such as: calcium antagonists, ACE inhibitors, various antiarrhythmic drugs, etc.

If you think you or another person has a heart seizure, call 112 immediately!

Don’t worry if you are not sure if this is a heart seizure. It is better for the medical staff to arrive at the call's place and verify that this was your suspicion only than to arrive when it is already too late to save a life.

Please note that the information above is for educational purposes only to give you an idea of the symptoms, causes, diagnosis, and treatment of angina and heart seizure.

Please remember that a patient with chest complaints should always consult a doctor - do not try to diagnose yourself! Self-medication can lead to a fatal result!