Chest pain is both common and very scary. It can also be the first symptom of a heart attack which in itself can be a fatal event. The universal advice for anyone who experiences chest discomfort especially if it a persistent sensation of heaviness, tightness or constriction, is to call an ambulance and get to a hospital as soon as possible. Despite this heavily publicised recommendation, I am still surprised on a daily basis to find patients in my hospital coronary care unit who admit to having had symptoms of chest discomfort for several hours or days but chose not to call for help in the hope that it would spontaneously settle down. In this blog I wanted to explain why it is not okay to wait.

Chest discomfort as a consequence of heart disease is caused most commonly by a reduction in the blood supply to the heart becoming compromised. The heart is a constantly pumping muscle and its cells need oxygen to function. The oxygen is delivered to these cells via blood which reaches them through blood vessels called coronary arteries. Each coronary artery (we have 3 main such arteries) supplies a different part of the heart. If the coronary artery were to suddenly block off (and it can do this very suddenly and within minutes due to the formation of a blood clot), the cells supplied by that vessel would become deprived of oxygen and start suffocating. As the cells suffocate, the patient experiences chest discomfort. The longer the cells are left to suffocate, the more likely they are to permanently die and these will never regenerate. 

The only thing to stop them suffocating is to relieve the obstruction as quickly as possible. This can be done in a hospital setting through the use of clot-busting medication or mechanically opening the blood vessel up again with a stent or bypass. Once the cells die, they stop causing pain. Hence the presence of pain indicates living albeit suffocating cells. The termination of pain points to dead cells. So if a patient waits to see if the pain has gone then usually by that time the damage is already done and the patient has been left with permanent heart damage. If this damage does not kill the patient, it is very likely that it will have a significant impact on the patient for the rest of their life and the result is a terminal condition called heart failure where the heart because of the damage is unable to keep up with the body’s requirements. This is why it is never a good idea to wait and see.

 Always remember, living cells hurt. Dead cells don’t. Time matters!

I hope you find this useful.

 

Tags: Chest pain; angina; heart attack