Atypical Chest Pain
Understanding Atypical Chest Pain
The symptoms of atypical chest pain are experienced outside the chest bone and it is described as a sharp and sudden pain which is very short-lived. Atypical chest pain can be the result of acid indigestion, overexertion, spasms or headaches. Physicians indicate that those with lower pain thresholds are likely to register atypical chest pains and these are also people more likely to be susceptible to anxiety or depression. The pain is similar to ischemic heart disease related pain and can be felt in the left chest, throat, shoulder, abdomen, back or arm. It differs from cardiac pain in that it does not have an accompanying heaviness or squeezing sensation and its location is slightly different also.
As this is very similar to the symptoms experienced by those experiencing an ischemic heart attack the primary response from medical professionals is to figure out whether it is a cardiac or non-cardiac episode. When the pain is non-cardiac, it can be triggered by gastrointestinal or musculoskeletal problems. Doctors are also very alert to gauge if a person experiencing the pain is showing signs of psychiatric pressures.
There is no decisive proof that can be obtained from a patient experiencing atypical chest pain. Doctors are trained to decide what prompts the pain by looking for evidence of atherosclerotic disease such as peripheral vascular disease, cerebro-vascular disease and congestive heart failure. Clinical history plays a major role in helping doctors diagnose. They often make an educated probability analysis in determining if a patient is having ischemic heart disease and this is based on a range of factors such as age, gender, lifestyle and health history. Those seen as high-risk patients are taken through a battery of diagnostic tests to pinpoint the source of the pain.
Given that physical examination in and of itself is not conclusive, there are a few things that are done in hospital emergency rooms to help clarify the nature of the pain. One of these is assessing the health history of the patient to determine their degree of risk. A patient’s response of nitroglycerin is used sometimes as an inconclusive but useful test. A less than 3 minute response to nitroglycerin, in terms of reduction of pain, could indicate ischemic heart disease but this response is also typical for those suffering from spasms or colic. Several emergency rooms also try giving patients a mixture of gastrointestinal medicines to rule out indigestion related pain. This cocktail is usually a mix of liquid antacid and xylocaine, and includes an antispasmodic. This is again not seen as a decisive test. These tests can provide some relief for the patients and can buy time for dealing with the core problem.
An exercise treadmill test is seen as the only standard test that offers significant additional insight into atypical chest pain. A patient with difficult to categorize chest pain, who is seen as at moderate risk of ischemic heart disease, can be monitored for symptoms of chest pain, heart rate, blood pressure response while the person is exercising. If the patient reaches a vigorous heart rate response during exercise it can provide useful data.
Atypical chest pain is at best a temporary diagnosis and cannot be treated as a complete understanding of the situation. Doctors will use a combination of tests and clinical history to move towards a more conclusive pronouncement because if it is ischemic heart disease it will have to be handled with appropriate intervention. If it is non-cardiac pain, it will again be useful to know what caused the episode and address either the gastrointestinal or musculo-skeletal root of the problem. If the episode is a manifestation of stress in an excitable patient who is processing other issues as physical pain, doctors may recommend a psychiatric counseling approach to dealing with the problem rather than think in terms of medication.
Patients experiencing pain in the chest region should not assume that they can figure out the differences themselves and are best advised to visit a medical facility to have a professional assess the situation. Because, while clinical history and risk factor are helpful in determining ischemic heard disease, there are many people who do not show any prior signs of a heart condition and who have no apparent signs of being in any risk group, who still do have heart attacks.