Your Health

Never neglect chest pain

For some unknown reason, coronary heart disease is very common among our people. Whether it is the coconut oil in our food or the stress of life in this country or whether it is just something in our genes, nobody knows for sure - but the fact remains that during 1999, heart attacks killed more Sri Lankans than even Prabhakaran's mob.

One of the earliest symptoms of coronary heart disease (where the arteries that supply blood and oxygen to the heart are narrowed or blocked) is chest pain. Typically, such pain (referred to as angina) is described in medical textbooks as a heavy, throttling pain that is felt in the centre of the front of the chest, comes on with physical exertion and often travels up to the neck or the shoulder and arm. Patients usually talk of the pain being like "someone squeezing or compressing the centre of the chest" and they generally associate it with a feeling of nausea or light-headedness.

The important thing to remember about angina is that it does not always occur in this typical manner. Sometimes, people can get angina if they are emotionally upset - some event that evokes sadness or anger can precipitate an episode of angina. When people talk of heartache, this is not just a picturesque description - heartaches can actually be brought on by constriction of diseased coronary blood vessels precipitated by strong emotions.

One of my patients - a fit, slim, health-conscious man in his late forties who ate sensibly and exercised regularly - used to get episodes of chest pain from time to time. These were quite unlike the typical textbook descriptions of angina - they never came on when he jogged or swam, but only occurred when he got angry. Every time he lost his temper, he would feel this tightness in his chest - a feeling that passed off after five or ten minutes.

Initially I would have put down his symptoms to something unrelated to his heart - but just to make sure that we were not missing an atypical case of heart disease we arranged for him to get a stress test done. This test involves exercising on a treadmill for about fifteen minutes while your heart is monitored with a continuous ECG.

My patient's stress test showed up an abnormal ECG tracing - not enough to confirm heart disease, but enough to cause concern to the cardiologist. In view of the fact that both his parents had suffered heart attacks in their fifties, the specialist suggested that he have a coronary angiogram done. The latter is a test that requires a tiny catheter or tube to be inserted through a blood vessel in the groin so that a dye can be injected into the circulation. Through X-ray screening, this dye can be followed into the blood vessels going to the heart, and can clearly show up any narrowing or blockages in these vessels. The entire procedure can be done under local anaesthesia, and requires only one day in hospital.

What a good decision that was! My patient's angiogram showed narrowing in three of the smaller coronary arteries - not enough to warrant surgery at present, but certainly enough to explain the cause of his symptoms and justify doing something to correct it. He is now on a very carefully controlled "minimum-fat" diet, together with some tablets (one that aims to bring his cholesterol down as low as possible, one to slow his heart rate and low dose aspirin to prevent blood clots forming in his circulation).

Thanks to his doing all the tests required, we now have an idea of the state of his heart and coronary vessels, and he is taking steps to protect himself from suffering what would otherwise have been an inevitable heart attack.

The moral of this story is this: Never neglect chest pain. The chances are that it is something non-serious, because the majority of chest pains people get are due to muscle cramps or gastritis or acid reflux. But every once in a while a patient can present with atypical angina - and seeing your doctor and getting them properly investigated can prevent your episodes of heartache progressing into a fatal heart attack.

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