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Chest
Pain/Coronary Artery Disease
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Chest pain is a symptom that may be caused by almost any
condition affecting the thorax, abdomen, or internal organs. Chest pain due to the heart
is frequently caused by coronary artery disease. This type of chest pain frequently
requires an immediate visit to the emergency room to rule out a heart attack.
Risk Factors of Coronary Artery Disease
1. High blood pressure
2. Diabetes
3. High cholesterol
4. Cigarette Smoking
5. Obesity
6. Family history
Symptoms
Coronary artery disease usually leads to chest pain during
exercise and possibly even at rest. This pain may occur either at low levels of exercise
or at very high levels. Pain occuring at very high levels indicates a good prognosis. Pain
occuring at low levels indicates a poor prognosis. Associated symptoms of chest pain due
to the heart are sweating, shortness of breath, nausea, and possibly vomiting.
Diagnosis
A. The doctor will discuss with the patient the severity of the pain and whether the
chest pain is of new onset.
B. The doctor will do an electrocardiogram to determine whether caracteristic changes are
present which may indicate a heart attack.
C. A complete physical examination should always be performed. Even when the chest pain
indicates that it may not be cardiac in origin, a cardiac etiology must, nevertheless, be
ruled out.
D. Possible causes of chest pain not due to the heart include:
1. Muscular chest pain.
2. Costochondritis (inflamation of joints between the cartilage and the
bone components of ribs).
3. Gastrointestinal conditions
E. The most common chest pain due to the heart is due to coronary artery disease. Chest
pain due to coronary artery disease is referred to as anginal. New onset of anginal chest
pain requires immediate medical attention and probable admission to the hospital.
Diagnosis of chest pain due to coronary artery disease frequently requires performance of
a stress test either by itself or in conjunction with a radioactive substance (nuclear
stress test) or in conjuction with an echocardiogram during exercise.
Treatment
Chest pain due to coronary artery disease may be treated by use of medications
such as beta-blockers, calcium channel blockers, and nitrates. The importance of aspirin
to prevent the reccurance of a heart attack or in the treatment of new onset of angina
which is not stable has been proven in numerous studies. If the cholesterol is high,
cholesterol reducing agents and/or diet must be employed. If necessary a cardiac
catheterization with opening of the affected artery in the case of an occlusion may be
carried out. In the ultimate case, coronary artery bypass grafting may be necessary.
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