CHEST PAIN, ANGINA & HEART ATTACKS
One of the most common symptoms of suspected heart disease, chest pain, can be a sign that your arteries are getting narrowed or blocked with fatty cholesterol deposits called atherosclerosis. This causes Ischaemic Heart Disease (IHD) and results in a lack of oxygen to the heart muscle on exercise. This discomfort or pressure in the chest can spread to the arm, jaw or neck and is known as angina pectoris.
If the symptoms occur at rest this could be unstable angina, a sign that the atherosclerotic plaques are prone to rupture. Severe prolonged chest pain at rest could of course be a heart attack (called a myocardial infarction, or ST elevations myocardial infarction (STEMI)) and you need to dial 999 and go straight to hospital for treatment. In this situation the plaque has ruptured and caused a blood clot (thrombus) to completely block off the heart artery. Time is of the essence to get into hospital to get the artery unblocked and blood flow restored to deliver oxygen to the heart muscle. Large heart attacks can cause significant damage to the muscle of the heart and heart dysfunction (heart failure).
But there are many causes of chest pain arising from the lungs, bones, muscles, nerves and stomach that can also mimic heart pain. There is a reason that “heartburn” is called what it is as it can mimic heart disease or heart attacks.
Risk factors for developing ischaemic heart disease are many. They include high blood pressure, high cholesterol, high body weight, poor exercise levels, poor diet, smoking and diabetes. There is also a tendency for it to run in families.
A typical pathway to investigate this would be a cardiology consultation with an ECG where we would review your history, risk factors and medication.
Thereafter special tests are usually ordered. This often consists of an echocardiogram – a ultrasound examination of your heart to assess the muscle function and valves – and a CT coronary angiogram. The CT scan is a very accurate and helpful way to detect early calcification and narrowing in the coronary arteries. We increasingly use this as our first line test for investigating coronary artery disease.
Sometimes a stress test is needed or a catheter angiogram. The stress test makes your heart beat faster, using medication or exercise, and then we look for evidence of lack of oxygen to the heart muscle with an echocardiogram, a nuclear camera or a MRI scan.
A catheter coronary angiogram is where we pass a small long tube called a catheter up through the wrist artery (or leg artery) to the heart and inject dye into the heart arteries and take some pictures. This usually provides the answer to whether you have significant coronary artery disease, and we would plan therapy with appropriate medication and possible stents or bypass surgery.
The most important part of therapy though is probably medication and a review of your lifestyle to ensure that you keep yourself as healthy as possible to avoid matters getting worse in the future. The most important medicines will be aspirin, statins, beta-blockers and ACE-inhibitors. Coronary artery disease can now be very successfully and safely managed with the above and does not necessarily mean you will suffer a heart attack. The earlier the problem is detected the better.