Chest Pain - The Nebraska Medical Center

Uploaded by NebraskaMedCenter on 20.12.2011

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.