We always hear about chest pain in association with heart attack. The word is buzzing with malignant connotation. Does chest pain really mean warning for heart attack or there is more to this?

I am here to say that yes, indeed chest pain is a warning for heart attack. It needs to be taken very seriously; it means go to the emergency room right away. But also many other things can cause chest pain. Most common of all is the stress of mind that gives tension and spasm of the spine and chest wall muscle, increases gastric acid production and esophageal acid reflux. Underlying gastrointestinal conditions such as peptic ulcer disease and abdominal obesity certainly would aggravate and exacerbate the reflux symptomatology. Chronic recurrent acid burn to the esophagus would cause esophageal bleeding and erosion. Over time, this could lead to the development of esophageal cancer. In fact, gastroesophageal related chest pain gives exactly the same presentation as cardiac angina, with chest pressure or tightness or deep pain, which may radiate to the back, shoulder, neck, jaws, and left or both arms. They are also relieved by nitroglycerin.

Stress related chest pain is more common in younger people like college students, struggling with self-expectation, and high goals in life. Lover and young married couples trying to understand their relationship and the meaning of life and love are another example. Statistically speaking, this pain is more common in women than in men. I suppose this is one instance of proof that women have more heart than men, but it gets better.

True cardiac related chest pain is time sensitive, a ‘time bomb’ that must be evaluated immediately. Pain is caused by imbalance of oxygen supply and demand to the heart muscle. Commonly, the underlying pathology involves the presence of coronary artery disease. A coronary artery is the blood vessel that supplies the heart muscle with nutrients and oxygen. The heart is a muscular organ, which can be trained stronger with enough exercise, good diet, and plentiful rest. However, What is unique about this muscle is that it is continuously contracting and relaxing, pulsating and in motion. I also believe that the heart is highly connected to one’s inner feeling, love and emotion. This special quality is what draws myself to the study of cardiology. Managing patients with heart disease should always incorporate the inner side of the person, and thus a well patient is a happy one. Anatomically, each cell of the cardiacmuscle is capable of contracting and relaxing, given adequate nutrients and oxygen, because each cell has muscular and electrical capacities to function on its own at random.

Coronary artery disease starts with damage to the inner lining of the vessel wall called ENDOTHELIUM. The disease progression could be rapid if the offending factors are left untreated. The final end result is coronary artery blockage of varying degree. It can be a discreet blockage or a diffuse disease. Interestingly, chest pain is not reflective of the severity of the disease. Chest pain or angina pectoris could be the earliest sign that there is a problem with the coronary integrity.

Coronary artery is complex and diverse from person to person. Although many new discoveries, and knowledge have been obtained over the past 25 years, much more remains to be learned and understood. Many offending factors, cofactors and subfactors have been considered. They are components of cigarette smoking, undesirable cholesterol ratios, and uncontrolled hypertension. The presence of ESSENTIAL HYPERTENSION and DIABETES MELLITUS compound the risk and weaken the coronary multiple folds.

Each of us is born with genetically predetermined coronary behaviors, strength and longevity. Family history of coronary artery disease at a young age, which used to be younger than age 50 seemed to get younger each decade, is an important risk factor. Much more importantly is the behaviors, environmental and diet factor. These factors are modifiable, improvable, potentially correctable, and this is where I come in. They say that being male is also a risk factor for early development of coronary artery disease. I have some doubts. It seems unfair and it really is unfair if it is as simple as that. Further recent, large studies regarding the protective effects of estrogen for coronary artery disease, failed to show statistically significant benefits in comparison to placebos, and therefore estrogen supplement is not recommended for the sole purpose of coronary disease prevention. Supplementation is contraindicated for those with family history of breast cancer.

A healthy lifestyle is multifaceted, but it begins in the heart and mind. Exercise and a healthy diet will improve the odds of premature development of coronary artery disease, but will not always prevent heart attack. The latter has more to do with fate and the genetically predetermined coronary behaviors and longevity. The least that we all should do is to lower those risk factors that are so far known, those I have mentioned above.

I have tried to briefly introduce my favorite organ, the heart and its coronary. They are complex and beautiful. One could try to get to know them really well, but to say that one could control them is ignorant. I will be back next time with interesting topics related to weight loss and cardiovascular fitness.

Courtesy of Dr. Budi Bahureksa
Board Certified in Cardiovascular and Internal Medicine