Chest Pain – The Nebraska Medical Center
October 29, 2019
All kinds of chest pain and we see this every
day. It’s one of the biggest features that enter the emergency department and one of
most frequent complaints that we have from people coming to get a cardiology consultation.
It occurs from various issues. It can occur certainly from cardiac pain but it can also
occur from muscular skeletal discomfort from prior injury. It can be associated with pulled
muscles or sore muscles from coughing. Sometimes coughs can be violent enough, in the flu season
for instance with a bad bronchitis they can actually cause costochondritis, which is pain
at the junction of the rib and the cartilaginous portion of the rib or sternum.
The most important characteristic of cardiac pain is the fact that it occurs with exertion
and a crescendo manner and then goes away in a decrescendo manner when the exertion
stops. It tends to get worse over time. Over a space of a week or two it will get worse.
The pain of a myocardial infarction or a heart attack tends to be much more severe than that
but it still has the crescendo flavor to it. It tends to be more oppressive, it may be
associated with shortness of breath or sweating and in general an impending feeling of doom.
The best strategy is to actually call your physician and talk about the pain with them.
Certainly if the pain is fairly sudden, not horribly severe and has a pleuritic nature
to it, in other words, it decreases with respiration and so forth; there is little reason to run
off to an emergency room. If it is associated with some other symptom such as sweating,
shortness of breath or it gets worse when you lie down then sure that needs to be presented
to an emergency room. Well that is a tough one; one can have cardiac
discomfort that seems very much like esophageal reflux. There is a burning quality to cardiac
pain sometimes. Reflux can come on in a crescendo manner; it gets worse when you lie down. So
that’s sometimes a little bit confusing and requires further evaluation. It’s very common.
If, on the other hand, it promptly goes away when a person takes an antacid that would
be very non-typical for cardiac pain. Sometimes people have tried these remedies and sometimes
they have not. Any discomfort that has that crescendo flavor to it, vague in location,
truly uncomfortable, gets worse when they lie down, unassociated with changes in respiration
and especially if they have risk factors of high blood pressure, high cholesterol, family
history, a prior cardiac event, those people ought to be a little more willing to come
and discuss it with a professional. We see people in their early 30’s that have
coronary artery disease. It’s vastly more uncommon than it is to see them in their 50’s
and 60’s have events. Nonetheless it does occur. In people with any risk in their family
I think they ought to at least get a blood test, check their blood pressure and perhaps
do that on a yearly basis or every other year if it’s a lower risk. Certainly diabetics
and younger people who have already been diagnosed with hypertension they should definitely be
under the care of a physician.