Chest pain can be due to angina, caused by poor circulation of blood to the heart, known as coronary artery disease. Cardiac chest pain can present in many different ways but typically occurs on exertion and is often described as a heavy or tight sensation, in the centre or left side of the chest, radiating towards to the left arm, neck or jaw. Chest pain has several potential causes including arising from the lungs, chest wall or stomach, or may not in fact be due to a heart problem.
An early specialist assessment is important for chest pain, especially if angina is suspected, and particularly if you have cardiac risk factors such as cigarette smoking, diabetes, high blood pressure, raised cholesterol or any family history of coronary artery disease.
Investigation of chest pain
Patients with suspected angina, after specialist cardiac evaluation, will usually need further investigations including:
- 12-lead Electrocardiogram (ECG)
- Exercise tolerance test (ETT)
- Non-invasive tests including CT coronary angiogram (CTCA), dobutamine stress echocardiography (DSE) or nuclear myocardial perfusion scan (MPS)
- Invasive procedures including coronary angiography
Treatment of angina
If a diagnosis of angina and coronary artery disease is confirmed, medical treatment usually starts with taking a blood thinner such as Aspirin, a cholesterol lowering drug (statin), emergency GTN spray and specific anti-anginal medication to control symptoms. It is important to specifically target and control known cardiac risk factors such as smoking, diabetes, high blood pressure, elevated cholesterol, and achieve lifestyle modification with diet and aerobic exercise.
Patients with angina may require further invasive procedures such as a coronary angioplasty procedure with stent insertion or cardiac bypass surgery.