Chest pain is one of the most common reasons why patients are referred to me for evaluation. There are several causes of chest pain, and one of the most concerning causes is from blockages within blood vessels that supply the heart.
When there is a blockage, less oxygenated blood can flow to the heart tissue causing it to become ischemic. Patients with inadequate blood flow to their heart may experience chest pain that is often described as severe pressure beneath the sternum, that is worst with physical activity, and relieved with rest or nitroglycerin. This pain my spread to the jaw or arms and be associated with nausea, vomiting, and sweating. Angina is a word used to describe this type of chest pain.
There are two types of angina: stable angina and unstable angina. Stable angina refers to symptoms that are stable over time and do not change in frequency or severity. Patients with stable angina are comfortable at rest. These patients may experience symptoms of chest discomfort at varying levels of physical activity. Chest pain occurs because the oxygen demands of heart tissues increase as it pumps harder and faster but there is insufficient blood flow due to blockages within the arteries supplying the heart. As soon as the patient rests, the heart can pump less vigorously, demand for oxygen decreases, and the pain goes away.
Unstable angina occurs when there is new onset chest pain or an increase in frequency or severity of the chest pain. This may occur when a plaque in one of the major coronary arteries breaks off and causes clot to form around it, acutely blocking the flow of blood to the muscles of the heart and may be a precursor to a heart attack.