Atypical Chest Pain

Never Underestimate Atypical Chest Pain

There is a term used to indicate a condition in which a person does not experience the classic symptoms of angina is called atypical chest pain. there is association with atypical symptoms of heart problems as well as non cardiac. When you feeling of pressure or squeezing chest pain that is usually felt when the activity that in medical terms is referred to as stable angina. Angina is the most common symptom of coronary artery disease, which is a heart condition characterized by a reduced supply of oxygenated blood to the heart. a person can be said to suffer from atypical chest pain when the pain experienced by the patient does not have the attributes of atypical angina. 

Unlike the atypical chest pain, which is brought about by physical exertion, and is felt under the breastbone, it may not be felt under the sternum and may also radiate to other regions. Seen from the number of cases is believed that men were more likely to experience typical chest pain during a heart attack than women. In case of a typical heart attack, chest pain is experienced towards the left section of the chest, and usually radiates to the left shoulder and arm, jaw, and the back. When the pain is radiating to other regions and other symptoms are experienced, one is said to be experiencing atypical symptoms.

Atypical Chest Pain symptoms

There may be mild to moderate chest pain, followed by profuse sweating and when a person gets heart attack, the pain may spread to back or even left shoulder shortly. Chest pain originating from other causes may have similar symptoms with discomfort feeling in the chest.

Atypical Chest Pain Causes

 
Contrary to many people’s belief, heart attack is not the only cause behind chest pain. There are many moderate to serious condition which may cause chest pain.

Heart attack occurs when normal blood flow is disrupted or when the arteries get blocked. It may cause severe chest pain and people who are obese, smoke, drink and having diabetic are more prone to heart attack.

Angina is a condition in which there is there is not sufficient supply of oxygen to the heart through blood-flow. It can be because of any reason like blockage in blood vessels or narrowing of blood vessels.

This may cause atypical chest pain but it is not life threatening. Some people may get angina while doing exercises and during heightened emotions which will fade away when they rest for a while.

Atypical chest pain is also caused by aortic dissection (tear in the lining of aorta), pulmonary embolism, and due to collapsed lung. Rarely when there is a hole in the wall of Gastrointestinal (GI) tract, it may cause chest pain. Pulmonary embolism is caused due to obesity, fracture or even sedentary lifestyle.

Atypical Chest Pain Treatment

Currently   more number of  patients as well as  the physicians are aware of the looming epidemic of CAD. The other major reason is the  lack of application of mind during  foirst clinical appraisal  and examination. Many of the patients with non cardiac chest pain  (Muscle, nerve , pleura )  are termed as atypical chest pain. Though some of the popular texts use atypical  chest pain  and non cardiac chest pain interchangeably , it is not  correct to do so. For example don’t ever label a  patient with chest pain with chest wall tenderness as atypical chest pain and order a cardiac work up .It  is a poor model to  emulate , that consumes time and resources!.Instead they should be diagnosed a confident non cardiac chest pain and dealt properly.

They should get a  complete physical examination,ECG, and  undergo exercise stress test. In the  screening of CAD , angina can be termed a hard sign,  atypical chest pain is a soft sign,  resting ECG is surprisingly  a soft sign again (unless you record it during chest pain). Exercise stress testing is  the ideal  investigation in evaluation of  chest pain.( 70-80% accuracy). This can be improved upon by Thallium, SPECT, stress echo etc. As of now coronary angiogram is considered the ultimate gold standard (Not pure gold !) to rule out  CAD.

You have to get to the nearest hospital for treatment immediately if you feel chest pain due to any reason. Medical treatment varies widely with the exact cause of atypical chest pain. In case of acute heart attack, angioplasty is done for clearing the blocks. Surgery is done if this therapy is not successful. In case of Angina, nitroglycerin is given for dilating the coronary arteries. For aortic dissection, medicines are given immediately to reduce the heart rate to get immediate relief from pain. If necessary, surgery is performed for correcting the aorta. For pulmonary embolism, treatment is given by giving external oxygen supply to the patient.

You can read my other guide on Pain Behind Knee