By Femi Ogunyemi
A couple of recent deaths has necessitated this reminder about acute onset pain in the chest. Both were young men, fit , agile and seemingly in good health. Perhaps because of a false sense of youthful security, both men had missed regular physical checkups. The first started complaining of pain in left side of the chest mid morning. He took ordinary analgesics and rested. The pain went away but returned late afternoon, this time in the chest and lower back. He decided he would visit his Doctor…..tomorrow. Sadly tomorrow never came.
Soon after dinner, while watching television, he collapsed and died. The other man, in his thirties, athletic and muscular, was on a treadmill in the gym. He felt a slight tightness in his chest, rested a minute, and continued his workout. Twenty minutes later (enough time to have got to a hospital emergency room), he grasped his chest and slumped on the treadmill rails.
The sensation of squeezing, crushing or pressure on the chest could indicate many things – from “harmless” stress and indigestion to something as serious as an impending heart attack or angina.
Angina is chest pain that arises from beneath the sternum and is caused by reduced blood flow to the heart due to blockages in the main coronary arteries. Angina pain is usually a warning sign of coronary artery disease.
Symptoms of angina:
Chest pain – a few minutes of feelings of heaviness, tightness or crushing pressure beneath the sternum. Triggers include emotional stress, strenuous exercise and heavy lifting. The most common angina pain – stable angina – lasts only a few minutes and occurs during physical exertion such as climbing the stairs, or during mental or emotional stress. Symptoms disappear immediately with rest or medication. It does not indicate an impending heart attack.
Unstable angina is more serious than stable angina and it can occur even at rest. The chest pain could last as long as 30 minutes and does not go away with rest or medication. It may progress to a heart attack when complete blockage of the coronary artery occurs. Heart attack chest pain: Chest pains associated with an impending heart attack are more intense than angina pain and last longer than 15 minutes. Rest cannot bring relief.
During a heart attack chest pain may be associated with nausea and vomiting, sweating, breathlessness, chest muscle pain, fast irregular heartbeats, dizziness and may spread to the neck, arms and shoulders. Chest wall pain is generally harmless and felt as sharp pain or tenderness in the bones, cartilage or muscles that make up the chest wall. It may be due to an acute viral or bacterial inflammation, gastrointestinal tract problems, or even allergy.
Pulmonary embolism: A blood clot in a lung artery – a condition called pulmonary embolism – could also cause sudden, sharp chest pains. This occurs when the legs are immobilised for a long time as in long distance travel in a coach or plane. A clot forms in the veins of the leg, dislodges and travels into the arteries of the lungs where it causes a blockade. The chest pain of PE is often accompanied by breathlessness and a fast heartbeat. It worsens with cough or deep breaths.
Aortic dissection: This is due to splitting of the layer of the wall (dissection) of the aorta, the main artery in the body and is usually related to very high blood pressure. The pain is usually described as a tearing pain in the chest, radiating to the back. The dissection may extend into the origin of the aorta and block off one or more of the coronary arteries, leading to a heart attack. This is likely what happened with the first patient described above.
Keep a close tab on your cholesterol levels and blood pressure. Don’t ignore the chest pain that suddenly hits you while at rest or during walking or exercising. Sudden, severe and recurring chest pain unrelieved by rest is a (treatable) medical emergency. If the chest pain lasts more than 15-20 minutes at rest or if it is accompanied by nausea, sweating, shortness of breath or loss of consciousness…..get medical attention fast.