Chest Pain: What’s Normal and What’s Not

When you think about chest pain, the first thing that comes to mind is probably a heart attack. But, chest pain can come from sources other than your cardiovascular system. So, how can you tell what’s a worrying heart concern and what isn’t?

At Northwest Houston Heart Center, cardiologists Dr. A. Adnan Aslam and Dr. Roy Norman offer state-of-the-art diagnostic facilities to address the cause of chest pain and advanced treatments to manage it when it’s cardiac-related. In this blog, they address what is and what isn’t normal for cardiac-based chest pain.

What is angina?

Angina is the term for pain or discomfort in your chest caused by your heart muscle not getting  enough oxygen-rich blood. You feel pressure or squeezing in your chest that may radiate into your jaw, neck, shoulders, arms, abdomen, and/or back.

Angina isn’t a disease. It’s a warning sign of heart disease, most commonly coronary artery disease (CAD), a condition in which plaque builds up in the arteries leading to the heart, narrowing the conduits and forcing the heart to work harder than normal.

As CAD progresses, you may feel pain and pressure most often during physical activity or stress. When you stop the activity or your stress disappears, the pain and pressure go away. If the blockage becomes severe, you may have pain for longer periods, and it may happen at rest. If you fail to treat the underlying problem, you set yourself up for a potential heart attack.

Women experience angina a bit differently than men. Their discomfort may be less about chest pain and more about nausea and vomiting; pain in the neck, jaw, throat, or abdomen; an upset stomach; or shortness of breath. This is because they more often develop heart disease in the small arteries that branch from the coronary arteries, a condition called microvascular disease.

Up to half of women who complain of angina symptoms and undergo cardiac catheterization don’t have obstructive CAD.

The many heart-related causes of angina

While cardiac-related chest pain is most often caused by CAD or a heart attack, it may also be caused by:

• Coronary artery dissection (a torn artery)
• Pericarditis (inflammation in the sac around the heart)
• Hypertrophic cardiomyopathy a (thickened heart muscle)
• Aortic dissection (a tear in the aorta, the body’s largest artery)
• Aortic aneurysm (a weak area or bulge in the aorta)
• Mitral valve prolapse (a heart valve that doesn’t seal tightly)
• Aortic stenosis (a heart valve that doesn’t open)
• Heart rhythm problems

Dr. Aslam or Dr. Norman can determine if you have any of these problems through diagnostic testing.

A blood sample can determine if you have high cholesterol levels, which can lead to CAD.

Other tests include an EKG (electrocardiogram), which records the electrical signals in your heart, and an echocardiogram (heart ultrasound), which produces images of your heart in motion.

While these can catch many problems, you may need further testing, such as a cardiac PET (positron emission tomography) scan, an exercise EKG, or a nuclear stress test.

Treatment depends on the specific underlying cause of your chest pain and discomfort.

Non-cardiac chest pain

Chest pain can also come from lung or digestive issues, such as:

• Gastroesophageal reflux disease (GERD)
• Stomach ulcers
• Esophageal muscle spasms
• Esophagitis (an inflamed food tube)
• Gallstones
• Hiatal hernia (part of your stomach moves up the esophagus)
• Gastritis (an inflamed stomach lining)
• Pancreatitis (an inflamed pancreas)
• Pulmonary embolism (blood clot in your lung)
• Chronic obstructive pulmonary disease (COPD)

Chest discomfort can also result from a bruised or broken rib, swollen chest cartilage, or even a panic attack.

When diagnosing the cause, our doctors work first to determine if the problem is life-threatening or serious, then determines how serious the issue is. But even if your problem is less serious than a heart attack or CAD, it still should be treated. If it's non-cardiac-related, you’ll get a referral to a specialist who can help.

If you’re experiencing chest pain and discomfort, especially if it’s worse when you’re active and less so when you’re at rest, it’s time to come into Northwest Houston Heart Center for an evaluation. Give us a call at any of our locations (Tomball, Cypress, Magnolia, and The Woodlands, Texas), or book online today. You can also text us at 832-402-9518.