Chest pain is a very common symptom. Most of us will experience at least once in our lifetime. But when should you be worried? Could it be a sign of underlying heart disease?
Fortunately, the vast majority of chest pains are benign in nature and likely represent muscular or rib pain. These types of pains are sharp, localised and often reproducible by touching the sore area. Other causes can be related to reflux of acid material from the stomach to the oesophagus (food pipe), and this is more often felt after meals or when lying flat. Finally, many other types of benign chest pains come and go without a clear cause being established.
However, chest pain can be the first and only sign of underlying heart disease. When the heart muscle doesn’t get enough blood supply, a sensation of heaviness or tightness in the centre of the chest can occur. This is usually related to exertion (when the heart needs more oxygen) and relieved by resting, but can also happen during stress. Other features which suggest a cardiac origin for chest pains are the radiation of the pain to the left arm, neck or jaw. This type of chest pain is called angina and can represent a narrowed artery around the heart. The underlying condition is referred to as coronary artery disease and is a result of fatty deposition within the walls of the heart arteries
Individuals who smoke, those with diabetes or high cholesterol as well as those with a strong family history of heart disease are at higher risk of developing angina. You should see your GP or a cardiologist if you think you have angina, as early diagnosis and treatment are essential to avoid more serious long-term consequences. Finally, many patients are experiencing chest pains following COVID infection, and whilst they are mostly benign, only a clinical assessment and investigations can determine their cause.
Importantly, if you have symptoms that feel like angina but are occurring at rest and lasting for more than 20min, you should call 999 as this could be a sign of a heart attack.
Dr Ricardo Petraco is a Consultant Cardiologist at Imperial College NHS Trust and Buckinghamshire NHS Trust as well as a Senior Clinical Research Fellow at Imperial College London. He is internationally recognized as a leading clinician and researcher inthe field of coronary artery disease and physiology. Dr Petraco completed his higher specialist cardiology training at leading university hospitals in London, including the Royal Brompton, St Mary’s and Hammersmith Hospitals.
His clinical work involves general cardiology with a focus on coronary interventions (stenting) and treatment of angina and heart attacks. As a researcher, he is interested in developing new diagnostic methods to improve the reliability and safety of coronary procedures as well as to improve patient experience during interventions.