Many people with chest pain fear a heart attack. However, there can be many possible causes of chest pain. Some are mildly inconvenient, while others are serious, even life-threatening. Any organ or tissue in your chest can be the source of pain, including your heart, lungs, oesophagus, muscles, ribs, tendons, or nerves
Suddenly there are lots of questions to be answered:
• What happens now,
• Can it be treated,
• Does it require an operation,
• Will I be able to continue working - or am I on my way to becoming a permanent invalid?
Your family will have their questions and anxieties too. Like you, they want to understand what is happening to you and to be reassured everything will be all right. Joining your local hospital's cardiac rehabilitation programme will help.
You will discover other people experiencing the same anxieties and worries. (Because it does help to discover other people are in the same boat!)
To look at it simply, the heart is just a mechanical pump, made up of very powerful muscles. Its job is to pumps blood around your body constantly every day of your life. Like any muscle in your body, it requires its own blood supply which brings it oxygen and nutrients to keep it alive, and able to do its job.
This blood supply travels to the heart muscle by way of small coronary arteries. These are normally able to respond to varying demands which the heart muscle makes by dilating (opening wider) or constricting (narrowing). When the heart speeds up, it requires more energy to do the extra work; so the coronary arteries dilate and deliver more oxygen to the heart muscles.
As the heart returns to its resting mode, less oxygen is required and the coronary arteries constrict to their original size. However, things sometimes go wrong with the coronary arteries, and the outcome can be either angina or a heart attack.
Angina is a specific type of pain in the chest caused by inadequate blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium).
It is brought on by exercise or effort and eases at rest or by using medication.
The pain varies from a dull ache to a sensation often described as a tight band around the chest and it rarely lasts longer than fifteen minutes on complete rest.
The cause of angina is simple to understand. When it's at rest, the heart is quite happy pumping slowly. However, exercise, effort and exertion cause the heart to pump faster and more forcefully. The heart muscle then requires increased oxygen supply.
Usually this is freely available from the coronary arteries, which dilate on demand. But if the coronary arteries are hardened or partially blocked, then the supply of oxygen to the heart may be restricted. Cholesterol or fatty deposits generally cause these types of blockages.
A heart attack (also called a coronary thrombosis or myocardial infarction), is caused by a complete blockage of one of the coronary arteries. As a result, one part of the heart muscle is permanently deprived of oxygen. The blockage is often caused by a blood clot formed inside a coronary artery.
A clot in the coronary artery interrupts the flow of blood and oxygen to the heart muscle, leading to the death of heart cells in that area. The damaged heart muscle loses its ability to contract, and the remaining heart muscle needs to compensate for that weakened area.
During the first hour or so of the blockage, the pain can be extremely severe. It's usually felt as a crushing sensation in the centre of the chest and can also affect the arms jaw and neck. It's also often accompanied by sweating, nausea and/or breathlessness, which lasts much longer than an angina attack.
In the first few days after a heart attack, the heart can be rather irritable with an accompanying erratic heart rate. This is why continuous observation in a health care setting is vital in those first few days.
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