Chest Pain and the Heart: Causes, Types of Angina and When to See a Doctor

Chest pain is one of the most frequent reasons for emergency room visits and cardiology consultations. While not all chest pain originates from the heart, it is essential to know how to identify the characteristics that suggest a cardiac problem in order to act in time. Timely evaluation can save lives.

Cardiac vs. non-cardiac chest pain

Not all chest pain comes from the heart. Multiple conditions can cause thoracic discomfort, and distinguishing between them is key to receiving the right treatment.

Cardiac causes of chest pain

• ●Angina pectoris (reduced blood flow to the heart due to narrowed coronary arteries)
• ●Acute myocardial infarction (complete blockage of a coronary artery)
• ●Pericarditis (inflammation of the membrane surrounding the heart)
• ●Aortic dissection (tear in the aortic wall, a serious emergency)
• ●Myocarditis (inflammation of the heart muscle)
• ●Coronary artery spasm (temporary constriction of a coronary artery)

Non-cardiac causes of chest pain

• ●Gastroesophageal reflux (heartburn that mimics cardiac pain)
• ●Musculoskeletal pain (costochondritis, muscle strain)
• ●Anxiety and panic attacks
• ●Pulmonary problems (pneumonia, pulmonary embolism, pneumothorax)
• ●Herpes zoster (shingles)
• ●Esophageal disorders (esophageal spasm)

What is angina pectoris

Angina is chest pain or discomfort caused by reduced blood flow to the heart muscle. It is a symptom of coronary artery disease and must be taken seriously.

Types of angina

• ●Stable angina: Occurs predictably during physical exertion or emotional stress. It subsides with rest or nitroglycerin within minutes. It is a sign that the coronary arteries have partial blockages.
• ●Unstable angina: Occurs unpredictably, can appear at rest, be more intense, or last longer than usual. It is a medical emergency indicating a high risk of imminent heart attack.
• ●Variant angina (Prinzmetal): Caused by spasm of a coronary artery. It usually occurs at rest, often during the night or early morning hours.

When to call 911

Seek immediate emergency care if your chest pain has any of these characteristics:

• ●Crushing, pressure-like, or squeezing pain in the center of the chest
• ●Duration longer than 5 minutes and does not subside with rest
• ●Radiates to the left arm, jaw, neck, back, or shoulder
• ●Accompanied by cold sweating, nausea, or vomiting
• ●Severe difficulty breathing
• ●Intense dizziness or loss of consciousness
• ●A feeling of impending doom

In cases of suspected heart attack, every minute counts. Treatment within the first few hours is critical to preserving heart muscle and reducing complications.

Diagnostic workup for chest pain

When a patient presents with chest pain, the cardiologist performs a systematic evaluation that may include:

• ●Electrocardiogram (ECG): The first test performed. It detects electrical changes suggesting ischemia (lack of blood flow) or an ongoing heart attack.
• ●Cardiac troponin: A blood test that measures proteins released when the heart muscle is damaged. It is the most sensitive and specific marker of heart attack.
• ●Echocardiogram: Evaluates heart function, wall motion, and valve status. It can reveal areas damaged by lack of blood flow.
• ●Exercise stress test (ergometry): Monitors the heart during controlled exercise to detect effort-induced ischemia.
• ●Coronary CT angiography or cardiac catheterization: Directly visualize the coronary arteries to identify blockages.
• ●Chest X-ray: Rules out pulmonary causes of pain.

Risk factors for cardiac chest pain

Certain factors significantly increase the likelihood that chest pain has a cardiac origin:

• ●Age over 45 in men and 55 in women
• ●High blood pressure
• ●Diabetes mellitus
• ●Elevated LDL cholesterol
• ●Active or passive smoking
• ●Obesity and sedentary lifestyle
• ●Family history of early coronary artery disease
• ●Chronic stress

Treatment and prevention

Treatment depends on the cause of the pain. For cardiac causes, options include:

• ●Anti-anginal medications (nitroglycerin, beta-blockers, calcium channel blockers)
• ●Antiplatelet agents (aspirin, clopidogrel) to prevent blood clots
• ●Statins to control cholesterol
• ●Percutaneous coronary intervention (angioplasty with stent) for significant blockages
• ●Coronary artery bypass graft surgery (CABG) for advanced coronary disease
• ●Aggressive risk factor management (hypertension, diabetes, smoking)

Preventing cardiac chest pain

• ●Keep blood pressure controlled below 130/80 mmHg
• ●Control cholesterol through diet, exercise, and medications if needed
• ●Do not smoke and avoid secondhand smoke exposure
• ●Engage in regular aerobic exercise (at least 150 minutes per week)
• ●Maintain a healthy weight
• ●Control diabetes with glycosylated hemoglobin below 7%
• ●Manage stress through relaxation techniques
• ●Get regular cardiac evaluations

If you have experienced chest pain, even if it has already resolved, do not ignore it. A comprehensive cardiac evaluation can identify the cause and prevent serious events. At ElderCardio, Dr. Elders Jimenez Iglesias has all the necessary diagnostic tools to accurately determine the origin of your chest pain. Schedule your appointment at Hospital Galenia and protect your heart.

Dr. Elders Jimenez Iglesias

Cardiologist · Nuclear Cardiology

Professional License: 13819257 · Specialty: 12543211