Dr. Viveka shares: “Acute chest pain is one of the most common reasons for seeking emergency department (ED) care, accounting for approximately 10% of all visits. Although chest pain increases the chance of acute coronary syndrome (ACS), after diagnostic evaluation only 10-15% of patients with acute chest pain actually have ACS. Dr. Bikky adds: “Chest pain is typical of heart disease but has typical features of sweating, malaise, palpitations and radiates to the back, neck, arm and jaw. Any type of chest pain until experienced is a medical emergency. Chest pain shouldn’t be ignored even if it’s not always associated with a heart attack, that’s why it’s important to rule out whether it’s cardiac or non-cardiac so you can seek help from your doctor or rush to a nearby hospital.
How to identify chest pain that indicates a heart attack
Tests such as ECG, serial heart markers, 2D echocardiography, medical history, and clinical and vital signs are some of the ways doctors confirm heart problems.
“Heart attack related chest pain is more to the left side of the chest radiating in nature and moderate to severe in intensity and continuous. Other causes of chest pain can be both sides or one-sided sides of the chest, but clinical and laboratory judgment is always needed to rule these things out,” explains Dr. Bikky.
Sharp or knife-like pain caused by respiratory movements or coughing, pinpoint and localized chest pain or discomfort in the mid or lower abdominal region, pain reproduced with movement, constant pain that persists for many hours, very brief episodes of pain lasting a few seconds or less, pain radiating to the lower limbs are some of the signs to watch out for.
Silent and painless heart attacks
Silent or painless heart attacks occur in 20-25% of people. Dr Pravin Kahale, Cardiology Consultant, Kokilaben Dhirubhai Ambani Hospital Mumbai elaborates: “The most common people experiencing this painless or silent heart attack, meaning very minimal symptoms, no typical chest pain are diabetics and the elderly. However, it is also common in many people who have mild heart attack symptoms such as dizziness, lightheadedness, nausea and vomiting, the episode disappears as mild acidity or minor dizziness. In reality, these patients have silent heart attacks. So various series show that silent or painless heart attacks can occur in 20% to 25% of people.”
Dizziness, fainting and fainting breathlessness and acidity. These are the common impersonators who, if not closely observed, would miss the heart attack diagnosis. The patient may not reach the hospital and many times even the ECG can miss 20 to 25% of the heart attack. Unless a blood troponin test is done, only then can these near misses be discovered. Even the ECG can sometimes fail to diagnose, adds Dr. Pravin Kahale.
Common reasons for chest pain
Pain in the lateral side of the chest may most commonly arise due to lung disorders and musculoskeletal and neuropathic pain reasons. It can also be due to pneumothorax, pneumonia which is a serious condition. Some common reasons are Cardiac (heart attack/angina, valvular heart disease/pericarditis), vascular (aortic dissection, pulmonary hypertension, and pulmonary embolism), pulmonary (pleurisy, pneumonia, pneumothorax, and tracheobronchitis), gastrointestinal (esophageal reflux, peptic ulcers, gallbladder disease, pancreatitis), musculoskeletal (Costochondritis, cervical spondylitis), infections such as Herpes zoster or even psychological.
