diease

Chest Pain


Chest Pain overview and Definition

Chest pain occurs due to variety of reasons. It is also known as Angina.


Pathophysiology

Pathophysiology:

Increase in the level of the LDL , BP, Diabetes and smoking might leads to oxidative stress formation.

Oxidative stress formation results in endothelial dysfunction and smooth muscle activation.

OXIDATIVE STESS:

This term refers to the formation of the free radicals. This term refers to any molecule that contains an unpaired electron in the outer orbit. This unpaired electron makes the molecule highly reactive, leading the molecule to either donate an electron to another compound or take up protons from another compound to obtain a stable electron pair. This can attach to the cell organelles and other structures resulting in damage to the plasma membrane and other structures. The mitochondria are the major source for the ROS.  The mitochondria produces most of the body’s required adenosine triphosphate through the process of oxidative phosphorylation. Oxidative phosphorylation is the main source for ROS.

This results is decrease in Nitric oxide which might leads to increase in the tissue angiotensin converting enzyme, local mediators.

These might result in increase in the secreation of endothelin, platelet aggregation factor, cytokines, proteolysis and inflammation.

As a result vasoconstriction, thrombosis, inflammation and rupture of plaque occurs .

 


Clinical signs & symptoms

  • pain or discomfort in the centre of the chest,
  • pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.

 Difficulty in breathing

  • Shortness of breathe
  • Nausea or vomiting
  • Light-headedness or faintness
  • A cold sweat
  • Turning pale

The common symptom of stroke:

  • Numbness of the face, arm, or leg, especially on one side of the body
  • Confusion, difficulty speaking or understanding speech
  • Difficulty seeing with one or both eyes
  • Difficulty walking, dizziness and/or loss of balance
  • Coordination
  • Severe headache with no known cause
  • Fainting or unconsciousness.


Differential Diagnosis

Electrocardiogram:

Electrocardiogram:

The heart transmits electrical impulses and electrodes on the skin can capture these recorded impulses generated as the electricity travels throught the heart muscle. The heart which has  decreased blood supply has lower energy and conducts the electricity in a different way.

Stress tests:

During exercise the heart needs more amount of energy and it should work harder and if the heart could be monitored and evaluated during the execise a test might uncover abnormalities in heart function. The patient is asked to walk on a treadmill, to ride a bicycle while simultaneously electrocardiogram is performed. Medications such as persantine, dobutamine and adenosine can be used to stimulate the heart if the heart cannot carry out such difficult tasks.

Echocardiography:

Ultrasound examination of the heart to evaluate the anatomy of the heart valves, muscles and its function are observed. This test might carried solely or it might be combined with other test such as the stress test.

Nuclear Imaging:

A radioactive tracer is injected into the vein and that can be used to indirectly assess blood flow to the heart. Technetium or thallium can be injected while a radioactive counter is used to map out how heart muscle cells absorbs the radioactive chemical and how it is distributed in heart muscle cells may help to determine indirectly whether the blockage exists or not. An area with no uptake of radioactive element suggest that the area is not getting the proper blood supply.

Cardiac Computerized Tomography and Magnetic Resonance Imaging:

Using these test the coronary arteries can be evaluated including hoe much calcium is present in the artery walls and whether blockage or narrowing of artery are present.

Cardiac Catheterization:

A thin tube is inserted through an artery in the groin, elbow, wrist into the coronary arteries. Dye is injected to assess the anatomy and whether blockages are present. This is called as Coronary Angiogram.

If the blockage exist it is called as angioplasty and the treatment to dilate the constricted vessel is known as Angiogram, a balloon is positioned at the site of obstructing the plaque.

A stent can be place din the blood vessels to dilate the narrowed blood vessels.

Holter and Event monitors:

These are portabale monitors and records the electrical activity during normal daily activity. A Holter monitor records the heart’s electrical activity for 24 -48 hours. An event monitor record the electrical activity of the heart only at certain times.

Myocardial Biopsy:

During this procedure your doctor might place a piece of heart in the microscope and he might look for the oppurtunities.

Genetic testing:

The genetic testing might reveals that the cardiomyopathy runs in the family or not.


Prevention

Avoid alcohol consumption

Avoid sleeping after the meals to restrain from gastrointestinal problems.

Avoid smoking

Reduce the fat foods

Be physically active

Reduces the stress

Reduce the intake of salt

Maintain good sleep