I have chest pain, am I getting a heart attack?

I am having chest pain. Is this the end? Well, there is no need to get paranoid as all chest pains are not from the heart nor do they lead to a heart attack. Most cases of chest pain are not even associated with the heart. This pain, angina, has some specific characteristics. It’s on the left side of the chest and may go towards your left arm. The pain typically increases with exercise, climbing stairs, lifting weight and having a brisk walk, but subsides at rest. It may be accompanied by a racing heartbeat, pressure over the chest, sweating and nausea. But there are always exceptions to the rule: patients with longstanding diabetes may only experience a few of these symptoms. Factors increasing the risk of heart disease is smoking, uncontrolled diabetes, increased bad cholesterol, uncontrolled hypertension, family history of sudden death or early heart disease in first blood relations, increased uric acid and stress – to name a few.

It is important to know there are many other causes of chest pain which may mimic a heart pain but is not coming from the heart. Among the commonest are gastric (stomach) pain, and bloating. Gastric issues are common in this part of the world due to water-borne infections like H. pylori; medicines like aspirin if taken on an empty stomach or not coated; stress; excess tea, coffee and fizzy drinks.  Symptoms — which generally arise after having food or having an empty stomach for a few hours —include pressure on the chest, burning sensation in the chest, difficulty breathing, sweating, and nausea. A similar pain may also arise from the oesophagus (food pipe). Gastric pain is related to food and not exercise or activity. The pain is relieved by simple measures like having half a glass of milk neither cold nor hot, antiacids and desi totkaas. If the pain is recurrent over a long duration, it is safer to see a gastroenterologist.

Pain from the neck (cervical pain) may also partially resemble cardiac pain and can go towards shoulders and left arm. It worsens with neck movement and may cause a current-like sensation towards the shoulders. Such a pain lasts for hours unless medication is given. This pain comes from a bad alignment of the spine causing nerve compression. The reason for such a pain could be poor posture, particularly in tall individuals, working long hours on the computer and not stretching, post-menopausal women with poor bone density, and low vitamin D and calcium levels. This pain is chronic in nature and may respond well to painkillers and physiotherapy. In such a situation, the patient should see an orthopaedic or spine specialist and watch his/her bone density, calcium and vitamin D levels.

Sharp chest pain like pinprick for seconds is from the muscles and nerves of the chest and usually self-curing.

My advice is to be logical and assess your risk factors. If you are under 30, exercise regularly, are non-smoker and non-diabetic with no family history of heart diseases, the pain is unlikely to be heart-related. However, if you are above 30 and have some or all risk factors like being a smoker, diabetic, hypertensive, have high cholesterol and family history of heart disease, you must get your chest investigated.

In a situation where you feel you’re having a heart attack, you’re recommended to immediately take an aspirin 300 or 325mg (unless contraindicated); have moderate deep breathing to help improve oxygen supply to the heart; and rush to the closest emergency with the provision of an ECG (electrocardiograph) and a blood test for cardiac enzymes.

Panic, though unavoidable, does not help as it raises the heart rate and blood pressure. Research has shown that reaching the hospital within one hour from the onset of chest pain — the golden hour — and appropriate management produce a better outcome.