Cardiac Chest Pain

What is the heart and how does it work?

The heart is a muscle inside your chest, which pumps blood around your body to your vital organs. It’s important that your organs receive blood filled with oxygen to keep them alive and working well. Your heart receives its own supply of blood full of oxygen, from a few vessels called the coronary arteries. These arteries wrap around your heart and keep it alive.

What does cardiac chest pain feel like?

Cardiac chest pain (sometimes also called angina) is a specific kind of pain or discomfort felt by people when their heart is not receiving enough blood or oxygen. It is often described as a feeling of pressure, tightness or squeezing in your chest. It can feel like a crushing, severe pain. The pain can be very intense. It may also spread across your back, to your shoulders, up to your jaw or down your arm.

At the same time, people often describe feeling very faint, clammy or sweaty. Some people become very nauseous and may vomit. Others may feel very short of breath.

What does cardiac chest pain mean?

Cardiac chest pain means the heart is not getting enough blood or oxygen. The coronary arteries that supply blood to your heart can become gradually blocked over time. Over many years, cholesterol (fat) from your diet sticks to the sides of your blood vessels, including the arteries supplying your heart. This is known as “atherosclerosis”.

Your coronary arteries can be partially blocked, and you may not feel any chest pain when you’re resting. If your chest pain only comes on when you’re exerting yourself, this is because your heart is working a lot harder and needs a lot more blood. At this time, the partial blockage in your arteries is slowing the blood flow to your heart, which doesn’t get enough oxygen to function properly. As a result, you get chest pain. This is called stable angina.

As your arteries become more blocked, you may experience chest pain at rest or without a trigger. This is because the blockage becomes so large that even when you’re resting, your heart is not receiving enough blood or oxygen to function. As a result, you get chest pain even at rest. This is called unstable angina.

If one of your coronary arteries becomes completely blocked, either by fatty build-up or by a blood clot, you will likely feel severe chest pain, along with the other symptoms described above. This is what we call a heart attack.

What should I do if I feel cardiac chest pain?

It is very important that you call triple zero (000) immediately if you feel chest pain. The only way to make sure you aren’t having a heart attack is to come to the hospital for tests. If you are having a heart attack, very quick treatment is the most important factor in your chances of survival. Do not go to your GP or pharmacist if you are experiencing chest pain.

How do we treat cardiac chest pain?

Because cardiac chest pain is a symptom, we need to treat the underlying cause as well as the pain itself. We have both short and long-term treatments for the causes of chest pain.

For short term treatment of unstable angina, you will likely be offered medications to slow your heart rate (called beta blockers) and thin your blood (called anti-platelet drugs). If you are having a heart attack, you will be admitted to hospital and may receive blood thinning medication, a stent, or need bypass surgery.

For long term treatment of any type of cardiac chest pain, you will be encouraged to adopt some lifestyle changes, including weight loss, increasing exercise, cutting down on foods with high levels of fat and salt, stopping smoking and drinking alcohol. You will also likely be offered medications like aspirin to prevent your blood from clotting and blocking your coronary arteries, a beta-blocker to slow your heart and improve the way it pumps, and a blood pressure medication called an “ACE inhibitor”, which has been proven to improve survival.

After some tests to assess your risk of a heart attack, you might also be offered a stent in one or more of your coronary arteries, or even a coronary artery bypass surgery (open heart surgery).

For treatment of the pain itself, you may be given a spray called Glyceryl Trinitrate (GTN), which you can spray under your tongue when you feel chest pain starting. It works to expand your blood vessels and improve the blood flow to your heart, relieving your pain. In the ambulance or at hospital you might also be given some morphine for the pain.