Chest pain

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What is chest pain?

Chest pain is not necessarily synonymous with heart attack. Most patients visiting the emergency department with chest pain have not heart attack. Usually the cause of their pain is less severe, such as of muscle origin. Even then, one must visit his doctor to clarify the etiology of his pain. Usually there is a delay to visit a doctor because one believes that the symptoms are not so serious or they will improve. Even if that happens, there is the risk of a permanent and severe damage to the heart or even death, if the cause of the pain were a heart attack.

Do I need to call an ambulance when I have chest pain?

You should call an ambulance if chest pain is:

  • Strong and new symptom for you
  • Accompanied by difficulty in breathing
  • Persists longer than a few minutes
  • Worsens when walking, climbing stairs or any other physical activity
  • Making you worried or feeling panic

Is chest pain the only serious symptom in heart attack?

No. There are other equally important symptoms. It is alsi likely to have a heart attack and be asymptomatic. The latter condition is more common in women, diabetics and people over 60 years.

Chest pain can be caused only by a heart attack?

No. Chest pain can be caused by many other reasons such as:

  • Other heart problems, eg infection – fluid around the heart
  • Muscle pain after activity that involves chest muscles
  • Diseases that cause pain in general, eg arthritis
  • Infection by the herpes zoster virus VZV, a condition associated with varicella, which causes painful rash
  • Any trauma to the chest, like surgery.
  • Gastrointestinal problems such as burning in the chest, heartburn, stomach ulcers or irritable bowel syndrome.
  • Lung diseases, eg pulmonary embolism, pneumonia, etc.
  • Psychological problems such as panic attacks or depression
  • Relaxation of the wall of large vessels in the chest (aorta)

What will happen if you visit the emergency department?

Doctors will examine you and then you will undergo some tests to clarify the etiology of your pain. Do not be surprised though if the cause of your pain is not immediately apparent. It is not always easy to diagnose the underlying cause.

The tests which you may undergo are the following:

  • Electrocardiogram – ECG. This test records the electrical activity of the heart. This helps doctors to determine if you suffer a heart attack.
  • Blood tests – When heart attack is present, there are various chemical substances released in blood, which can be detected with special tests.
  • Stress Test – During the test, you may be prompted to run or walk on a treadmill while an ECG is recorded. Exercise increases the heart’s blood needs. This test helps your doctor to clarify whether your heart is receiving enough blood supply. If you are not able to walk or run, your doctor may give you some medicine to assess your heart function under conditions of increased blood needs.
  • Cardiac catheterization. It is also known as coronary angiography. During this test, the doctor inserts a thin inflate tube inside the large artery of your leg or arm and then he forwards it to your heart. Then, he injects a contrast which is depicted radiographically. This contrast will depict if heart arteries are narrowed or clotted.