Monday Medical: Chest pain sends mixed medical signals |

Monday Medical: Chest pain sends mixed medical signals

Like Aladdin invoking the magic phrase that sends the portal to a cave full of treasure sliding open, such is the effect a patient declaring chest pain has on conscientious medical personnel.

This response stems from the fact that, until that particular symptom is accurately assessed, the assumption is that the individual is suffering from a cardiac-related condition and the doors to immediate and comprehensive care must yawn wide open.

But fortunately, the experience of chest pain does not always indicate the heart is at risk. And, in fact, the majority of the time it is not. This is why the distinction between heart-related discomfort and a host of other unrelated conditions must clearly be discerned.

Interestingly, when a person experiences bonafide cardiac discomfort, he or she rarely considers the perception as a “pain.” More commonly, the term used to describe the feeling is “tightness” or “pressure.” Sometimes, it’s the sense of being wrapped in a bear hug or feeling an elastic band being gradually tightened around the chest. But, when the word “pain” comes to mind, the source usually is not the heart.

True cardiac-related discomfort, also known as angina — or more technically “myocardial ischemia” — is the result of an insufficient amount of blood reaching the heart muscle through diseased, narrowed, plaque-filled vessels called coronary arteries.

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And the consequence of this mismatch between the demand and supply leaves the muscle literally thirsting or starving for blood. This in turn generates a feeling of squeezing, constriction or tightness in the chest. If it’s burning, aching or knife-like, it’s usually not cardiac.

Now, with every rule comes an exception. Many women, for example, present to the doctor or the emergency room with what physicians often label as “atypical” chest pain. And although these symptoms are rarely classic and tend to run the gamut of nonconformity, more often than not these unfortunate females are suffering from cardiac pain.

Up until recently, these symptoms had been discounted or minimized. But fortunately, during the past several years, the awareness of this type of presentation has been heightened to the point where these individuals now are provided with special consideration.

Also, whenever a person complains about chest pain, the context of the presentation needs to be taken into consideration. This arises from the fact that coronary artery disease rarely occurs in a vacuum. In fact, just the opposite is true. Several associated conditions, when present, alert the medical practitioner that heart disease is playing a role.

The most telling of these major risk factors include cigarette smoking, diabetes, hypertension, high lipid (cholesterol) levels and a strong family history. When one or more of these conditions are present, the index of suspicion for heart disease increases dramatically.

Factor in age, weight, gender and the degree of physical fitness and a portrait consistent with widespread vascular disease or “hardening of the arteries” starts to come into focus. What follows is an evaluation that may include calcium scoring, stress testing and even cardiac catheterization.

Finally, a comprehensive treatment plan emerges that usually involves medication, dietary restrictions, regular exercise and possibly angioplasty, stents and, in extreme cases, even coronary artery bypass surgery.

Despite what seems like a slippery slope into the black abyss of heart disease assessment and treatment, it still is possible to avoid the worst of it. And more importantly, it’s never too late to start taking care of your heart.

If an individual at risk can reliably follow a treatment program that deals with conditions such as hypertension, diabetes and high cholesterol, while embracing the positive lifestyle pursuits of a healthy diet and getting plenty of exercise, he or she can go a long way toward delaying or even eliminating the progression of the coronary artery disease that seems so prevalent in our sedentary, fast food-favoring Western society.

And perhaps, with those measures firmly in place, you and your loved ones can effectively avoid the need to assess the characteristics and the context of those worrisome chest pains.

Gerald Myers, M.D., F.A.C.C., is a board-certified cardiologist with Heart Center of the Rockies in Steamboat Springs and Craig. He can be reached at or 970-870-1035.

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