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A USER’S GUIDE OF YOUR HEART: CHEST PAIN DOES NOT ALWAYS MEAN HEART ATTACK
Virtually everyone who has had a heart attack or bypass surgery or has been told that he or she has heart disease fears another attack. That fear can take the joy out of life and sometimes can be actually debilitating. All of us know what it’s like to have one or more of the symptoms?chest pain, discomfort in the shoulder and arm, gastric disturbance, sweatiness, tightening of the jaw, rapid heartbeat, anxiety ?and think that the next one is on its way.
But those symptoms do not necessarily signal heart problems at all. A number of quite different conditions can closely imitate the pains of angina and heart attack.
In fact, depending on varying estimates, anywhere between 20 and 33 per cent of all patients having an angiogram are diagnosed as being free of heart disease. Yet even then, many continue to fear their symptoms.
It’s very important for you to realise that these other conditions exist, and to discuss with your physician the possibility that you might be suffering from them. Indeed, as many as half of all coronary heart disease patients have a non-cardiac condition that also causes chest pain. If that’s the situation for you, you need to clear the air and dispel unnecessary fears.
Gastrointestinal Pretenders. Often it’s not your heart but your oesophagus that’s at the root of your pains. That’s the muscular tube that conveys food from the mouth down to the stomach. When working properly, the contractions that convey the food are nicely co-ordinated and no one thinks much about it. However, stress, smoking, alcohol, diabetes and other disturbances can lead to painful spasms or cramps in the oesophagus. One form of the disorder causes contractions so strong and painful that it’s known as nutcracker oesophagus.
Another related condition, which some experts are beginning to think is the most common cause of non-cardiac chest pain, is called reflux oesophagitis or acid reflux. In essence this is an extreme case of heartburn. Muscles across the top of the stomach act like the lid of a pan and keep food and stomach acid from spilling out. As we age, these muscles weaken and allow acid to flow back up into the oesophagus. The result can be painful heartburn.
The symptoms often are similar, if not identical, to a heart attack. Patients wake up in the middle of the night sweating, with pain in the middle of the chest, a rapidly beating heart and tremendous anxiety. The more they think about it, the worse it becomes.
First, one can distinguish this from angina since it tends to last a lot longer. Angina will pass within two minutes, while reflux pain continues, sometimes for hours. Second, there are differences between oesophageal pain and a heart attack. The former tends to dissipate when you sit up and when you take an antacid, while those measures will give no relief from the symptoms of a heart attack.
There are diagnostic tests for these and other oesophageal problems. You may require the care of a specialist, a gastroenterologist. Talk with your family practitioner first.
Interestingly, oesophageal problems can often be eliminated by the very same steps needed to recover from heart disease: quit smoking cigarettes, control stress and work on effective methods of relaxation, and cut way back on fat intake in your diet. I can’t begin to tell you how many nights I lay awake in the past with those pains and symptoms, wondering whether I should immediately check into the emergency ward. Now that I’ve dramatically altered my lifestyle, I have no such scares. A very nice additional benefit.
Costochondritis. You’ve been exerting yourself a bit more than usual, and you wonder whether you’ve really overdone it. Suddenly you have a wrenching pain in the chest, actually in the rib cage. As you breathe in, the pain gets worse. A heart attack? Probably just an inflammation of a rib or the cartilage or muscle between the ribs. Remember that angina and heart attack pain is continuous: changes in position or breathing will not affect it. With musculoskeletal pains, on the other hand, such positional or breathing changes have an immediate influence.
Panic Attack. It’s now been estimated that one of every three out-patients who consult cardiologists for chest pain probably suffers from another great pretender known as panic disorder. People suffering from such panic attacks are defined as having discrete periods of discomfort or fear accompanied by at least four of the following symptoms: shortness of breath, choking or smothering sensations, faintness, dizziness, feeling of unreality, numbness or tingling, flushes or chills, trembling or shaking, fear of dying, and fear of loss of mental control. Studies have shown that 100 per cent of panic disorder patients report severe palpitations and a rapid heartbeat. Two-thirds report chest pain or discomfort. Most such patients believe they have a physical, not a psychological, condition. Women very often are afflicted.
What really is happening to bring on those symptoms? Panic disorder appears to be a malfunctioning of the sympathetic nervous system, the part of the involuntary nervous system that controls heartbeat and blood pressure. Combine this with the symptoms brought on, as we’ve just discussed, by oesophagitis, and you have a terrified man or woman who’s absolutely certain that his or her time has come.
But what can one do? First, remember that nothing you do will have an influence on a heart attack. Then find out whether you can make some of those symptoms go away. Try doing some relaxed deep breathing; realise that this won’t bring relief in mere seconds?you’ll have to concentrate and really work at it. Do some of your gastric symptoms go away with an antacid?
The first panic attack will be the hardest to deal with and might very well send you to the emergency room for an ECG to be on the safe side. If the doctor can detect no cardiac basis for your symptoms, you might start thinking about these great pretenders. The next time it happens, and it most likely will, you might be better prepared. Better still, in the meantime you will want to work harder on lifestyle modifications that can make such panic attacks a thing of the past.
The mere fact that there are non-cardiac reasons for chest pain points out the need for a good relationship with a family practitioner, general practitioner, or internist in addition to your cardiologist.
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