CHEST PAIN
Chest pain may be a manifestation of a variety of disorders, ranging from a harmless chest cold or heartburn to a life-threatening heart attack. To try to attain a diagnosis, it is important to ask these questions:
2. What is the nature of the pain?
4. How long have you had the pain?
5. Does the pain extend into the arm, neck, jaw, or abdomen?
ANGINA PECTORIS
Angina pectoris (“angina”) is caused by narrowing or obstruction (spasm or actual occlusion) of the coronary arteries, which supply the heart muscle. The pain, which lasts from 3 to 15 minutes, is most often described as heavy and pressure-like (“squeezing,” like a weight on the chest); it is classically located beneath the breastbone (but may also commonly be present in the left front chest), with occasional radiation to the jaw, back (between the shoulder blades), and left arm. Rarely, it can radiate to the right arm. Associated symptoms include nausea, sweating, shortness of breath, anxiety, and weakness. It is commonly associated with exertion, emotional stress, or both, and may be more frequent at high altitudes (this is debated by doctors), where less oxygen is available. Symptoms are sometimes worse in cold weather or after meals. “Atypical” angina is pain that occurs at rest or that awakens a victim from sleep. Women more commonly have nonclassic symptoms of angina than do men. These include irregular heartbeat, “sharp” or “stabbing” pain, pain that can be reproduced by pressing on the chest, and pain that is localized to underneath the breast. Additional symptoms in elders include shortness of breath with exercise, weakness, or sweating. A first-time angina episode, change in the pattern of existing angina episodes, or increased frequency of episodes may portend a heart attack. Angina may be relieved by rest. Persons with known angina are generally prescribed drugs: nitrates (e.g., isosorbide dinitrate), beta-adrenergic blockers (e.g., metoprolol), or calcium channel blockers (e.g., nifedipine, verapamil, or diltiazem). They also may be taking low-dose aspirin and a “statin” drug to achieve target lipid (e.g., cholesterol) levels. Any person who is taking a nitrate should not be prescribed medication for erectile dysfunction (e.g., silfenadil citrate [Viagra]).
