Every chest pain is not a heart attack

Dr KK Pandey *

People in our country are scared of heart attack, so much so any mild stress in chest or burning sensation will straightway land them up in a doctor’s clinic. An urgent ECG and multiple blood tests will be performed and ultimately result will turn out to be negative.

Even then majority of the people will not be satisfied with negative result and would insist for admission against medical advice in a ICU of a nearby nursing home to be doubly sure and unnecessarily would spend four to five days in ICU with 24 hours monitoring and daily blood tests and other investigations. After spending time and money as well, in nursing home, they feel greatly relieved as though an impending heart attack has been preempted.

The story does not end up here and even after become so anxious that they continue to take a variety of medicines to prevent any further chance of heart attack. This type of incidence is happening repeatedly in every corner of our country day in and day out.

With the result, any person who had a complaint in the past of even a minor chest wall discomfort has already labelled himself a heart patient and therefore drastically changed his daily routine and life style, thinking that his days are numbered and anytime he can embrace death. Sometimes such persons begin to give a serious thought to writing a will, in advance.

After all why there is a panic of heart attack

To a great extent, our media especially television is responsible for creating havoc among people about impending heart attack. Everyday either through special programs or through advertisement, a panic is created in the mind of viewers about heart disease and attack.

For example, if Safola oil is not used for cooking, heart attack then is inevitable and you are advised to get medi claim policy lest you suffer a heart attack in future and your family and children become orphans.

Another important reason is the abundance of cardiology clinics in every nook and corner of India, because every general physician (Internal Medicine) proclaims himself as a heart specialist. If you go to any street of a small town in our country, you will find a lot of sign boards proclaiming ‘Physicians and Heart specialist”. When every physician has become a heart specialist, the number of patients under constant threat of heart attack is bound to increase exponentially ??

When to suspect an heart attack ?

If you are 40 years of age or above, and you are either a diabetic or a smoker or a tobacco addict (Zarda, Khaini, Chaini) and you develop mild chest pain or heaviness on walking fast or climbing a staircase or else you develop breathing difficulty while doing physical exercise, the possibility of heart problem or disease cannot be excluded. The peculiar thing about this type of chest discomfort is that the chest pain and heaviness disappear immediately after you stop walking or doing physical exercise.

A cardiac or angina pain may appear in left hand, left side of neck and jaw while walking. If you want to get rid of mental tension arising out of this type of peculiar chest pain, first get your treadmill test (TMT) done. If TMT result is doubtful or suspicious, get Dobutamine-induced Stress Echo (DSE) done and clear your doubt and feel relieved if this test turns out to be negative.

To be doubly sure and to feel completely relieved of the tension of any suspected heart problem, the last and best thing is multi slice CT coronary angiography. For this special investigation, you neither need to be admitted in hospital nor require to be putting a wire/pipe in the groin (invasive procedure) as in a conventional angiography.

When there is a very little possibility of a heart attack ?

If you are below 40 years of age and you are neither overweight, nor have any co-morbid medical conditions like diabetes and blood pressure, chances of heart disease are less likely. If you are nonsmoker, nonalcoholic and not tobacco addict and follow stress free daily routine, you are then less likely to be suffering from heart attack. If pain is confined to right side of the chest and does appear on only during coughing or sneezing or normal breathing, chances of having heart problem are only five percent.

If you develop chest problem only after eating oily, spicy and heavy meals, chances of heart disease are minimal. In such situations, one should seriously think of diseases other than heart.

Causes of chest pain other than the heart

In our country, the major cause of non-cardiac chest pain is the inflammation of inner wall of the chest. What happens when the outer covering of lung if inflammed, rubs against the inner wall of the chest during deep breathing, chest pain becomes unbearable, this medical condition is called ‘PLEURITIS’.

This pleuritis is an early indication of an impending collection of infected water inside the chest cavity and tubercular infection is responsible for this in majority of such cases. A sufferer of such condition in our country keeps taking pain killer for a long time without any proper investigation and treatment, and eventually lands up in a serious problem.

If the problem of pleuritis is not tackled promptly, it leads to collection of an infected yellow water around the lung inside the chest. This condition is caused primarily by tuberculosis and secondarily by pneumonia. If this condition develops, immediately consult a chest surgeon or a thoracic surgeon.

Collection of Pus inside the chest is also a cause of chest pain

In our country, it is very common to see collection of pus inside the chest. If pneumonic or other type of infection becomes uncontrollable due to delayed or inadequate treatment, the infected water collected inside the lower part of the chest turns into a full-fledged pus. The amount of pus, even if it is in a small quantity, remains unresponsive to all kinds of antibiotics.

In our country, collection of pus inside the chest if neglected, happens to be the most important cause of chest pain. This needs a surgical clearing of pus by a thoracic surgeon, only then this problem is resolved.

Cervical Spondylitis is also a reason for chest pain

In our country there is generally a complete apathy among people for physical exercise. People are even averse to walking, let alone do exercise. They continue to sit for long hours in the same body posture in front of television or computer. This habit of prolonged sitting and lack of exercise causes adverse effect on the backbone of neck and upper part of chest.

Due to lack of exercise, the joints of backbone becomes hard and inflexible, with the result an undue pressure is exerted upon nerves passing through back bone to hand, shoulder and chest. This leads to pain in chest, hand and people mistake it for either heart disease or impending heart attack.

With the result, such people adopt a life style and a daily routine, solely guided by a constant fear of an impending heart attack. This leads to a low self-esteem and very low work efficiency. You are advised to consult a thoracic or a chest surgeon.

Weakness of chest wall muscles is also one of the reason

Quite often very young people complain of chest pain. This pain generally occurs in the middle of the front of the chest. This pain is caused by chest wall weakness and it increases in intensity on coughing or sneezing.

The sudden jerky pain in the chest momentarily makes you feel lifeless. This condition is called in medical terms as “Costo Chondritis”. Victims of this problem are generally those people who either do not drink milk regularly at all or consume milk in a very small quantity. It has been observed that the low Vitamin D level in blood causes chest wall weakness and pain.

If you take daily 500ml of less fatty toned milk, protein rich balanced diet, vitamin-rich salads (300gm) and fruits (350gm), you will rarely suffer from chest wall muscle weakness and pain. Daily exposure to sunlight for a few hours helps in relieving of chest pain. Some people complain of chest pain on taking some special type of curd-based Indian foods like, KADHI, RAITA, Ice cream and Dahi-Bade.

The reason being, abnormal sensitivity of chest walls muscles towards these food items. Those suffering from this abnormal sensitivity should avoid these special food items continuously for days, and take warm food and some pain killer for one or two days.

Inflammation in Food Pipe is also a cause of chest pain

In our country, quite frequently at food stalls, people relish oil–rich and fried food items like CHAAT-PAKODE, SAMOSA, DHOKLA etc along with chillis, spices and achaar. This habit of eating unhealthy food items leads to inflammation and ulcer in the wall of stomach. When food pipe situated inside the chest gets inflamed, it gives rise to a severe chest pain simulating a heart attack. Whenever one eats food, one feels heaviness, pressure and pain in the middle part of the front of chest.

Now a-days, an excessive use of alcohol also leads to severe inflammation (Commonly called in Hindi SHOJIS or SOOJAN) of food pipe. People in India label this type of chest pain or discomfort as ‘GAS’ meaning thereby that an entrapped air column in the belly is causing problem.

After reading and understanding above-mentioned points, I am sure you would have become wiser and therefore I request you not to consider every chest pain as heart attack. If you are still in doubt, get above mentioned investigations done to clear the doubts, otherwise there will be always perceived threat of impending heart attack, and this will certainly undermine your self-confidence and lower your work efficiency.

Therefore, in an event of suspected heart problem, get suggested and heart-related investigations done to rule out any heart disease and get a mental peace and consult a thoracic surgeon to find out other causes of chest pain, so that you remain healthy mentally as well as physically.

* Dr KK Pandey wrote this article for The Sangai Express
The writer is Senior Thoracic & Cardiovascular Surgeon, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi.
and can be contacted at drpandeykk(AT)gmail(DOT)com
This article was webcasted on February 07 2022.

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