Chest pain: A warning sign of an underlying cardiovascular disease

Dr Bipeenchandra Bhamre, a Cardio-Thoracic Surgeon, Sir HN Reliance Foundation Hospital and Research Centre, shares how angina (chest pain) can be a warning sign of a life-threatening cardiovascular disease

man with heart problems
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Angina is a pain experienced in the centre of the chest, just beneath the breastbone. The pain can be felt under the jaw or on the left shoulder in some people. It usually occurs after exertion like walking a few hundred meters, swimming, cycling, and others.

A few people experience it as heaviness in the chest like something heavy is kept on the chest, short of breath, and sweating.

There are many reasons that one may experience pain in the chest. It can be as simple as acidity, and acidity pain subsides within a few minutes on taking an antacid, sometimes this pain may signify something more dangerous than indigestion.

Angina is the chest pain that is caused due to reduced blood flow to the muscles of the heart. The pain mimics that of acidity/gastroesophageal reflux disease; therefore, tends to be ignored. Angina could be a warning sign of an underlying cardiovascular disease.

The chest pain that occurs in angina is due to diminished oxygen supply to the heart, which subsequently affects the strength of the heart muscles. There is reduced blood supply which leads to pain.

Classically, patients complain of tightness or a constricting band around the chest. This pain may also be referred to the shoulder, arms, sometimes jaw. Usually, stress/exertion triggers pain and subsides within a few minutes of rest.

Other symptoms of angina attack may include sickness/nausea, breathlessness, pain in the belly region, a sudden feeling of tiredness.

The blockade of blood vessels and resultant reduction in blood and oxygen supply to the heart may be caused by Coronary Artery Disease (CAD). In CAD, there is a gradual build-up of plaque (fatty material) resulting in narrowing of the artery.

The blockage of the coronary artery is more common in men than in women. Sometimes this blockage may occur in the small arteries that branch out from coronary arteries, this condition, known as Microvascular Disease (MVD), tends to affect young people.

The main variants of angina are as follows:

Stable angina refers to chest pain that may occur during physical activity like walking for a few hundred meters, and then after taking rest, it subsides.

The second type is unstable angina which occurs and worsens over time. Unstable angina may also occur at rest or during sleep, sometimes without any previous trigger or cause.

The third variant, Prinzmetal angina or coronary artery spasm, is a temporary discomfort or pain that occurs due to constriction of one or more coronary arteries, which may intermittently block the blood supply to the heart muscles. The sudden spasms may vary in intensity, from minor to severe, and in extreme cases, it may block the blood supply to the heart which may result in death.

As previously mentioned, in microvascular angina (also called Cardiac syndrome X), coronary arteries appear normal on the investigation. Therefore, it is important to consider blockages in the tributaries/branches, which may go unnoticed and cause symptoms or even death of the individual.

The line of treatment in cases of angina is as follows:

  • Stay aware of the symptoms of the condition diagnosis can be made after performing an ECG, 2D echocardiography, and stress test. Consult a cardiologist.
  • Reach to your nearest hospital/ doctor as soon as possible, in case of an attack.