Having Chest pain is a very uncomfortable to all of us, which is extremely alarming for both young and old adults. Most of you who know someone had experience heart attack, it is usually believed that the pain is in the chest. However, in reality, that doesn’t mean when you experience symptoms of cardiac diseases, you have automatically chest pain. The pain could actually be somewhere else. In addition, you must know that the symptoms of heart diseases in female are surprisingly quite different than male. It is important you must be familiar with those symptoms so that you can seek medical care as soon as possible, and if you respond earlier, you have a great chance to save your loved ones.
In here I am going to provide you a basic explanation about the kinds of cardiac diseases that mimic muscle-like pain. There is 4 heart disease I will specifically explain to them since they are extremely common.
Angina is defined as an imbalance between blood supply and demand in the Heart. Usually, when you exercise for a long time, there will be an increase oxygen or blood demand on the heart, but normally it is usually compensated by the continuous blood supply in the heart. In some people, when they have a high cholesterol in their body that suddenly causes fatty deposition in the arteries known as atherosclerosis, these narrowed the size of the arteries, leading to decrease blood supply to the heart. In that case, when the oxygen or blood demand is greater than the supply of the blood in the heart, these causes Angina Pain, also known as Chest pain.
This pain usually takes only less than 5 minutes, and for that patient who has a history of Angina, they were prescribed by a doctor to have a Nitroglycerin with them wherever they go. This is a very important drug because this will help dilate the coronary artery, which increases the blood supply relieving the chest pain.
There are 3 kinds of Angina:
A. Stable Angina: This kind of chest pain only happens during exercises and is usually relieved by rest
B. Prizmental Angina: This kind of chest pain is caused by spasm in the coronary artery which can happen a few hours early morning at rest, this pain will disappear by itself;
C. Unstable Angina: Also known as Pre-infarction Angina; by the name itself this kind of Angina is the worst of those 3 since this will predispose to Myocardial Infarction and this is very alarming and medical emergency is needed as soon as possible, this kind of angina pain takes more than 30 minutes and position can relieve this pain.
2. Myocardial Infarction
When the person has unstable angina due to ischemia for a long time, there is a blockage of blood flow to the heart. We must understand that tissues need oxygen in order to be sustainable. Our heart, in this case, is covered by a Myocardium which they are made of a Cardiac muscle tissue. If there is no oxygen blood flow in the heart, the muscle tissues will start to die, which they are undergoing necrosis. As you can see in the picture above, that black circular area are due to a necrosis of the Myocardium.
For Myocardial Infarction, Male and Female have a bit different signs and symptoms. In Male, they usually experience a chest pain which feels like a heavy, squeezing and crushing sensation. Just to give you a clear picture, imagine an elephant step on straight to your chest, what do you think will you start to feel like? That is how you experience that kind of pain. In addition, you experience shortness of breath, sweating, nausea, and fatigue
In addition to that, the pain is also referred to the left shoulder down to your little finger of the hand, which is in a form of ulnar distribution, left jaw, left upper back or neck. The reason why do you have those referred pain is because your heart is actually supplied by a spinal nerve of C3-T4 segments. Just to give you a clear background of those nerve supply, your tip of the shoulder is supplied by C4 segment, the little finger is supplied by C8 segment, your upper back is supplied by C3 segment. So what I am implying, is that if the heart is affected, all those nerve segments is affected as well, which causes those referred pain.
For Female, the signs and symptoms are usually like heartburn, abdominal pain, fatigue, nausea, isolated right bicep pain, anxiety or depression. Moreover, their pain is usually relieved by Antacid to compare to Nitroglycerin.
If you notice any female person who experienced that kind of signs and symptoms, take it as a MEDICAL EMERGENCY AND DON’T IGNORE IT. Because most of the female patients they misunderstood it as a Heartburn, stomach pain or GERD, which is in facts a Myocardial Infarction.
This is an inflammation of the Pericardium in the heart, which is caused by infection, which could be either viral or bacterial. Aside from chest pain, this pain can also refer to other sites which are similar like Myocardial Infarction
What makes this unique is that unlike Myocardial infarction, which the pain cannot be relieved by anything, Pericarditis has an aggravating and relieving factors that affect the pain. The pain is relieved by sitting upright, leaning forward, kneeling in all four positions and even holding their breath. While the aggravating factors of pain are some muscle movement that involves long inspiration such as coughing, laughing, or deep breathing; lying on your back, or neck and trunk movement. Deep breathing; lying on your back, or neck and trunk movement.
4. Dissecting Aortic Aneurysm
There is an increase dilation or swelling of the aorta, which suddenly it will cause ruptured leading the blood to go out. Aside from having chest pain, it will be referred to the shoulder, in the middle back or lower back area. In addition, when you lie down, you can sense a heartbeat.
It is very important to know that in older adults, you must be very careful when you are exercising using weight lifting especially when you do Valsalva Maneuver (Holding their breath while doing something). That is because, this will increase the pressure in the arteries, causing big swelling or dilation, which will eventually cause rupture. If any older adult wants to perform weight lifting and has the history of this condition, this is considered Contraindication. Instead, he or she can just exercise using the bicycle with pedal resistance or using an elastic band instead of dumbbells or other heavy weight.
5. Congestive Heart Failure
Another problem also could be is having signs and symptoms of Congestive Heart Failure or CHF that we are not aware of. When we have a horrible cough and chest pain, we usually think it could possibly be from our lungs, such as bronchitis or viral flu, but what we didn’t know is that this could be one of the manifestations of Heart failure.
Congestive Heart Failure is divided into two parts, Left CHF and Right CHF. When having Heart failure, it depends on which side is affected, and you can either have one of them or both of them at the same time, which is possible if it is a severe case, although it is rare.
Left sided Congestive Heart Failure has signs and symptoms such as chest pain, nonproductive cough or dry cough, shortness of breath which aggravate when lying down flat in the bed known as “orthopnea”, in this condition you will even have shortness of breath in middle of the night when sleeping known “paroxysmal nocturnal dyspnea”, you also have a lot of fluid in the lung due to failure of your left ventricle function known as “pulmonary edema”, and lastly you feel tired and weakness regularly. Just remember that the sign’s and symptoms are mostly pulmonary involved, although you might think the problem is on the lung which could be misunderstood as either bronchitis, asthma, lung’s involvement or even bad flu. But the source of this problem is definitely from the heart itself.
Right sided Congestive Heart Failure, on the other hand, they are usually multisystem involvement, which means most of your organs are affected. The sign’s and symptoms could be like there is an excess edema or swelling in both of your legs known as peripheral edema. There is also a lot of edema or fluid in the abdomen, which looks like as if you have a big tummy known as “Ascites” , this is because of liver dysfunction. In addition to that, your liver will also be hypertrophy or enlarged which can cause discomfort in your right upper quadrant area. You will also feel that your vein in the neck is so enlarged which is not found in normal adults known as “jugular venous distension”
This picture on the side is what it look like an example of enlarged vein. Lastly, you will feel frequent urination in the night known as Nocturia
Now you are aware that kind of chest pain or other referred pain, you must always take them seriously. Because having a Heart diseases doesn’t usually start in the chest but rather in other referral areas. If you expect that you have either one of those sign’s and symptoms, it is extremely important to have yourself check up by a doctor. In fact, for those who age 40’s and above, it is highly recommended to have yourself check up regularly. Never underestimate those kinds of sign’s and symptoms, as they could kill a person in an unexpected time.
- Differential Diagnosis for Physical Therapists, 5th Edition from Catherine Goodman