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Chest pains: A symptom for many

health talk:with Dr Johannes Marisa

This week I want to talk about a common symptom that troubles so many people. Chest pains can give torrid time to patients. A good number of people have succumbed to chest pains some of which have been attributed to heart ailments, gastritis, lung infections. Those who ignore this symptom have faced numerous problems. Some people end up delaying their own treatments.

Chest pain appears in many forms, ranging from a sharp stab to a dull ache. Sometimes chest pain feels crushing or burning while in certain cases, the pain travels up the neck, into the jaw and even radiates to the back or down one or both arms. Many different conditions can give chest pains and chief among them are:

lHeart problems

lGastrointestinal issues

I, therefore, want you to know how the above mentioned conditions present and the respective chest pains. If chest pain is traced early, it will be of great value to patients.

Heart-related chest pains

The heart is on the left side of the chest except when one has dextrocardia. Majority of heart pains manifest as chest pains circulating around the left half of the chest. Chest discomfort or pain that is related to the heart may be described by or associated with one or more of the following:

lTightness in your chest

lCrushing or searing pain that radiates to your back, neck, jaw, shoulders

lPain that lasts more than a few minutes, gets worse with activity, disappears and returns. This may vary in intensity.

lShortness of breath

lCold sweats

Please be alert about heart pains. These pains can be due to the following:

lHeart attack — A heart attack results from blocked blood flow, often from a blood clot to your heart muscle. Result is sudden death. We have lost many patients from this.

lAngina — This pain is caused by poor blood flow to the heart. Can be due to plaque build- up on the inner walls of arteries. Cholesterol should be measured from the blood.

lAortic dissection — If the inner layer of the aorta separate, blood is forced between the layers and can cause the aorta to rupture.

lPericarditis — This is inflammation of the sac surrounding your heart. Usually there is sharp pain that’s gets worse when you breathe in or when you lie down.

Lung-related problems

Lung related chest pains usually come with other symptoms like coughing, Shortness of breath, night sweating, breathing in. Get proper history from patients and see if the pain is not associated with the above. Causes of such pains include:

lPulmonary embolism — This comes when a blood clot becomes lodged in the pulmonary artery, blocking blood flow to lung tissue.

lLung infection — Lung infections like pneumonia, TB can cause serious chest pains

lPleurisy — If the membrane that covers your lungs becomes inflamed, it can cause chest pain that worsens when you inhale or cough.

lPulmonary hypertension — This comes when one has high blood pressure in the arteries carrying blood to the lungs. This will produce chest pain.

lCollapsed lung-pain typically begins suddenly and can last for hours. A collapsed lung occurs when air leaks into the space between the lungs and the ribs.

Gastrointestinal problems

Disorders of the digestive system can give chest pains. These pains are usually associated with feeding or hunger. There are some foodstuffs that are associated with this like coffee, spices, beans, oranges, lemons, apples. Examples include:

lEsophagitis — Inflammation of the oesophagus which can come with acid reflux, can cause chest pain

lGastritis and peptic ulcer disease — these conditions give epigastric pains

lSwallowing disorders — Disorders of the oesophagus can make swallowing difficult and even painful.

Diagnosis

Once you have chest pains that are haunting you, try to identify the origin of the chest pains. Do not always attribute chest pain to heart ailments.

Investigations include:

lBlood tests — Blood tests include Full Lipid profile, Cardiac Enzyme

lChest X-rays — The condition of your lungs and the size and shape of your heart and major blood vessels can be noted.

lCT Scan — CT scans can spot a blood clot in your lung. Make sure you are not having aortic dissection.

Treatment

Treatment depends on the cause. If it is gastritis or reflux oesophagitis, one needs anti-gastritis medication like Omeprazole, Cimetidine, Ranitidine etc.

However, there are some drugs that are commonly used to treat common causes of chest pain. These include:

lArtery relaxers — Nitroglycerin, Isosorbide dinitrate or trinitrate

lAspirin

lThrombolytic drugs like streptokinase

lBlood thinners like warfarin

lBeta Blockers like propranolol, atenolol

lAcid suppressing drugs

lAntidepressants like Amitriptyline

Be wary about chest pains. Avoid heart attack. Get the necessary investigations. Don’t assume all is well. Get satisfied only when investigations are done.Till we meet again

lDr Johannes Marisa is a medical practitioner, educationist who can be accessed on doctormarisa@gmail.com

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