Angina - Chest pain

ENGLISH / MALTESE

Chest pain is not always dangerous. Chest pain can be divided into: 

  • Cardiac (related to the heart) 

  • Non-cardiac (not related to the heart)

What are the cardiac causes of chest pain? 

  • Heart attack (Myocardial Infarction)

    • During a heart attack, a heart (coronary) artery or one of its smaller branches is suddenly blocked, cutting off the blood supply to part of the heart. This classically presents with crushing chest pain, even at rest. A heart attack is an emergency and if the blockage is not quickly removed, part of the heart muscle is at risk of dying. 

  • Angina 

    • Angina is usually caused by the gradual narrowing of the coronary arteries (coronary artery disease) with fatty deposits resulting in reduced blood supply to a part of the heart. However, the blockage is not complete. This is known as atherosclerosis.

    • When your heart works harder, typically during exercise, your heart muscle needs more blood and oxygen. If extra oxygen and nutrients cannot be delivered, the lack of blood supply to the heart manifests as chest pain. 

    • The pain will usually subside with rest. This is called ‘Stable’ angina. 

    • Pain that is not relieved by rest is called ‘Unstable’ angina, often indicating an impending heart attack.

    • Angina pain may also be triggered by other non-cardiac causes that contribute towards an increase in heart rate. Anxiety or fever are two common scenarios.

“Cardiac chest pain is often left sided that may extend to your arms, neck, jaw, back or stomach. Other related symptoms include nausea & vomiting, sweating, dizziness, or shortness of breath.”

If you experience one or more of the above symptoms, early medical advice is strongly encouraged.

What risk factors could increase my risk of coronary artery disease?

  1. High cholesterol levels

  2. High blood pressure

  3. Smoking

  4. Diabetes

  5. Physical inactivity

  6. Obesity

  7. Family history of heart disease

  8. Alcohol consumption

  9. Older age

  10. Male gender 

Other less common causes of cardiac chest pain are pericarditis (inflammation of the sac surrounding the heart) and myocarditis (inflammation of the heart muscle itself). 

What symptoms may represent a non-cardiac cause of pain?

  • Pain on pressing your chest

  • Pain on breathing or on coughing

  • Pain on changing body position

  • Burning sensation in your throat and a sour taste in your mouth

  • Regurgitation of food

  • Difficulty in swallowing

What are the most common causes of non-cardiac chest pain?

  • Muscular pain: Chest wall muscles help in breathing. If these muscles are strained after trauma or following excessive stretching e.g after lifting a heavy object, chest pain may be felt which is made worse on movement and on breathing in. 

  • Anxiety and stress: Common cause of chest pain which may be quite severe 

  • Heartburn: Stomach acid causes inflammation of the stomach lining and/or the food pipe (oesophagus). You feel a burning sensation in your throat, a sour taste in your mouth and frequent belching. 

  • Bones and joints: Inflammation of one of the rib joints which is also usually worse on movement and on breathing in. This is called costochondritis. Another cause includes trauma to one of the rib bones.

  • Lung 

    • Pulmonary Embolism: A blood clot in the lung 

    • Pneumothorax: Collapsed lung 

    • Both classically cause sharp chest pain felt when breathing in and shortness of breath

  • Pancreatitis: Inflammation of the pancreas may cause upper abdominal pain which radiates to the back.

  • Aortic Dissection: There is a tear in the main artery coming out of the heart, often presenting as pain radiating to the back.

Take-Home Messages

Sudden, severe chest pain could represent a heart attack, and this is an emergency

Angina is gradual chest pain, felt on exertion, and subsides after rest. It is not an emergency, but you must see your doctor as soon as possible 

Keep in mind other non-cardiac causes of chest pain 

Maintain a healthy lifestyle to avoid cardiac-related complications 

HELP AND SUPPORT

If you have any questions regarding our article feel free to contact us on info@maltaheartfoundation.org or our Facebook page.

This article was authored by Dr. Peter Cassar and edited by Dr. Neil Grech, in collaboration with the Malta Heart Foundation and Maltese Cardiac Society.

Cardiac ConditionsMHF Admin - Matthew Farrugia