Chest pains

From: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Chest_pain (Better Health Channel, VIC)

Chest pain may be serious and you should always seek urgent medical help. Chest pain may be caused by poor blood flow to the heart leading to angina or by a sudden blockage in the coronary arteries resulting in a heart attack.

However, there are other possible causes of chest pain such as indigestion and muscle strain. Aside from the heart, the many parts of the chest that can cause chest pain include the lungs, oesophagus (gullet), muscle, bone and skin.

Because of the complex system of nerves in the body, the cause of the chest pain may come from elsewhere in the body, such as the abdomen. If in doubt about the cause of your chest pain, call an ambulance.

Symptoms of a heart attack

Symptoms of a heart attack include:

* Severe crushing pain in the centre of your chest or behind the breastbone. You may feel this as a squeezing, tightening, choking or heavy pressure feeling.
* Pain may spread to the shoulders, arms, neck, throat or jaw.
* Sweating.
* Feeling anxious, dizzy or unwell.
* A sick feeling in the stomach.
* Being short of breath.
* Symptoms that often last 10 to 15 minutes or more.

Symptoms may vary from person to person, and some people have few symptoms or none at all.

Angina and heart attack

Angina is a short-lived chest pain that occurs when the heart has to work harder than usual. This often occurs with exercise or high emotion, cold weather or after eating a large meal. It eases when you rest.

Angina does not cause damage to the heart but, if it is not treated, it may lead to a heart attack. Many Australians die of heart attack because they don’t know the signs or wait too long to act. New treatments for heart attack can save lives and prevent serious heart damage.

Heart disease risk factors

The risk factors for heart disease include:

* Smoking
* Lack of exercise
* High blood pressure
* Obesity
* High cholesterol
* Diabetes
* Family history of heart disease
* Gender, since males are at greater risk than females
* Age, since the risk increases as we get older.

It is important to remember that people without these risk factors can also have heart disease.

Other common causes of chest pain

The symptoms of a heart attack are similar to other conditions, so your chest pain may have nothing to do with your heart. Common causes include:

* Indigestion or stomach acid coming up the oesophagus (reflux). This common problem can be made worse by smoking, alcohol, coffee, fatty foods and some drugs. You may feel this as a burning pain in the chest. It often goes away quickly with antacid or milk.
* Muscle strains.
* Inflammation in the rib joints near the breastbone (costochondritis).
* Herpes zoster or shingles can cause chest pain before a rash forms.

Seek urgent medical help

With chest pain, every minute counts. The faster a person gets to hospital for treatment, the better. If any activity brings on chest pain, stop what you are doing and call an ambulance to report a possible heart attack. If you have any doubt about your pain, call an ambulance anyway. While you are waiting for the ambulance, suggestions include:

* Stop and rest quietly by sitting or lying down.
* Chew half an aspirin straight away, unless your doctor has told you to avoid them.
* Do not attempt to drive yourself to hospital. Wait for the ambulance. It has specialised staff and equipment that may save your life.

Diagnosis methods

Before medical treatment can begin, the cause of the pain must be found. You may have a lot of tests done including:

* ECG – electrical tracing of the heart activity.
* Blood tests – to measure markers from the heart and other organs.
* Chest x-ray – to look at the lungs, heart and major blood vessels of the chest.
* If angina is suspected – further tests may be needed to check the state of the blood vessels that supply the heart. An exercise stress test (on an exercycle or treadmill) may be arranged. You may be referred to a cardiologist (heart doctor) for more tests.
* Other tests – it is not always easy to diagnose the cause of chest pain. Your doctor may need to see you more than once to be sure, and further tests may be needed.

Taking care of yourself at home

If your doctor has ruled out serious causes of chest pain, it is likely you will make a full recovery. General self-care suggestions include:

* Follow your doctor’s advice about treatment.
* In the first few days at home, try to take it easy.
* Rest if you feel tired.
* Slowly increase your activity, as you are able.
* There is no need to limit work or strenuous activity, including sex, if you feel well.
* Even if you feel well, follow-up with your doctor is important. See your local doctor in the next day or two.

Reduce your risk of heart attack

Ways to reduce your risk of heart attack include:

* Stop smoking – call Quitline for help and support.
* Be physically active – enjoy moderate physical activity for 30 minutes or more on most if not all days of the week.
* Eat a healthy diet – enjoy a diet low in fat and eat plenty of cereals, grains, vegetables and fruit.
* Watch your weight – keep a healthy weight by eating a good diet and exercising regularly.
* Regular check-ups – see your doctor for regular check-ups. Take your pills as directed. Don’t stop your pills unless your doctor tells you to.

Where to get help

* Your doctor or Peninsula Private Hospital Coronary Care Unit on 03 9788 3490/1 for direct admission
* Emergency department of your nearest hospital
* Always call an ambulance in an emergency Tel. 000
* Heart Foundation Tel. 1300 362 787
* Quitline Tel. 131 848
* Vicfit Tel. (03) 8320 0100
* An accredited practising dietitian, contact the Dietitians Association of Australia

Things to remember

* Chest pain may be caused by poor blood flow to the heart leading to angina or by a sudden blockage in the coronary arteries resulting in a heart attack.
* Other causes of chest pain include indigestion, reflux, muscle strain, inflammation in the rib joints near the breastbone, and herpes zoster or shingles.
* If in doubt about the cause of your chest pain, call an ambulance.