Dear Readers,

Deborah H. is a 39-year-old New Kingston waitress who writes Lifeline with great concern about chest pains she has been experiencing. Deborah has had two heart tests (ECGs) done since this year and has seen both her family physician and a hospital doctor for her chest pain. The doctors have not found anything wrong with her and her general practitioner told her the chest pain was most likely caused by chest-wall muscle strain brought on by lifting and carrying trays and other items at work.

Deborah has been waitressing for more than 15 years without any illness and remains concerned that she is suffering from some sort of recent heart disorder. She asked Lifeline for an opinion.

The usual symptoms associated with acute coronary syndrome, which causes heart pain and the heart attacks include:

❒ Chest pain

❒ Referred pain (pain felt in other places)

❒ Nausea

❒ Vomiting

❒ Shortness of breath

❒ Light headedness

❒ Dizziness

❒ Fainting

The presence of pain which radiates to the shoulder, left arm or both arms increases the likelihood of acute chest syndrome being present.

Chest pain is a common occurrence and finding the real cause can sometimes be challenging. The initial effort usually requires ruling out cardiac causes of chest pain.

Important considerations involve not only properly detailing when the pain occurs, and how it is experienced, but also assessing the presence of risk factors such as diabetes, obesity, high blood pressure, high blood cholesterol, cigarette smoking and other factors.

The physician should also thoroughly examine the individual. Blood tests which check on heart-specific enzymes, in conjunction with the ECG, serve to further confirm or disallow the relationship of any chest pain being experienced being linked to cardiac causes.

People who experience chest discomfort with movement, or feel pain when the area where the pain is experienced, is pressed, (palpated) are at a low risk for heart disease being the cause of their pain. Non-cardiac causes of chest pain will include:

❒ Musculoskeletal causes

❒ Peptic ulcer disease

❒ Gastritis

❒ Cholecystitis

❒ Pneumonia

❒ Pleurisy

❒ Pericarditis ( inflammation of the external lining of the heart)

❒ Panic disorder (associated with anxiety)

Once heart disease has been ruled out as the cause of chest pain, the non-cardiac causes should then be considered and confirmed, or eliminated, as the cause of the chest pain if possible.

Deborah's occupation (waitressing) involves lifting heavy objects repetitively. A musculoskeletal cause such as chest-wall muscle strain, or costochondritis, would seem to be an obvious reason for her chest pain, in the event that her examinations and tests with her physicians have ruled out heart disease.

Even so, Deborah should check with her doctor for a follow-up to review her progress with therapy and lifestyle changes.

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