Chest pain & angina: what does it feel like and what causes it?
Chest pain & angina: what does it feel like and what causes it?
Dr Nicholas Robinson, an expert cardiologist, explains what chest pain is, how it is diagnosed and the differences between angina and a heart-attack.
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Content
7.24 -> Heart pain classically comes on with exercise,
such as walking uphill or rushing. There are
13.54 -> other typical features such as a constriction
or tightness in the chest and that the symptom
19.4 -> can be relieved by rest. Some patients however,
don't have the typical symptom and their symptom
24.74 -> may occur in the shoulders or in the arms
or in the jaw or the teeth. So diagnosing
31.14 -> angina or heart pain can be difficult. There
are some people who feel it like an indigestion.
37.37 -> And that's a really common situation. But
when walking, they describe a feeling of indigestion.
42.82 -> And of course, to the patient they don't naturally
think immediately of the heart.
49.74 -> Well, the first step in trying to establish
whether it's heart related pain is based upon
54.6 -> the history as we've discussed. And classically,
the symptom can come on with exercise. If
60.71 -> the symptom is classical, then it's highly
likely that the symptom is angina based upon
65.89 -> the history alone, but in most cases, we'll
require investigations to truly establish
71.82 -> whether there's underlying coronary artery
disease.
78.36 -> These days we have a fantastic set of non-invasive
investigations to initiate the diagnosis of
84.95 -> coronary artery disease. The mainstay in my
practise is a CT coronary angiogram. This
91.21 -> is a non-invasive test which takes ten minutes
to do and involves small x-ray doses and the
96.53 -> use of some contrast. And we can obtain superb
images of the coronary arteries in a rapid
102.969 -> non-invasive fashion. This is really helpful.
This has developed rapidly over the last few
108.229 -> years with the latest machines being fantastic
at diagnosing coronary disease. The second
114.139 -> form of a non-invasive test which I use is
a stress MRI scan, which looks to see if there's
119.539 -> any problem with the blood flow in the heart
arteries. The next step which is my area of
125.249 -> expertise is with invasive angiography. That's
the gold standard really for diagnosing coronary
131.32 -> artery disease. This is a procedure performed
under local anaesthetic as a day case. And
137.051 -> in my hands, from the radial artery. And this
is the best method to evaluate the true level
142.58 -> of coronary artery disease.
147.38 -> The main risk factors that we know about are
150.5 -> quite well-known publicly. Those are of course
smoking but also hypertension, raised blood
156.39 -> pressure, and importantly a high cholesterol.
There are others such as diabetes and carrying
162.86 -> extra weight. The main risk factor that is
often under looked and which we really do
168.97 -> need to focus on is the family history or
the genetics of coronary artery disease. So,
174.13 -> I see many patients either to treat symptoms
or for screening who've got a strong family
179.66 -> history of heart attacks or cardiac events
under the age of 60. So, the genetics is really,
185.86 -> really important.
190.66 -> Angina is classically a stable condition which
193.73 -> occurs with exercise. So, patients will describe
that after walking maybe 400 yards or walking
201.01 -> uphill or briskly, they develop a discomfort
and then they have to rest. The important
206.46 -> feature of a stable symptom, angina, is that
when they rest, the symptom goes within five
212.17 -> or ten minutes. A heart attack can be quite
difficult to diagnose, but typically or classically,
218.9 -> this occurs at rest. Sometimes in the middle
of the night but lasts longer than five or
224 -> ten minutes and can make the patient feel
generally unwell with breathlessness or exhaustion.
232.46 -> The classic symptom is a well-described tight
band across the chest; which can be a life-threatening
239.32 -> condition. Sadly, there are some people who
have a heart attack which is much more difficult
245.07 -> to diagnose with rather subtle symptoms of
mild discomfort at rest. And even more difficult,
251.15 -> there are some people who have a heart attack
with no discomfort whatsoever. And that's
254.93 -> quite common in the elderly and in diabetic
patients. So those patients who don't have
260.04 -> any discomfort may just feel generally unwell
or feel exhausted or have nausea or feel faint.
268.24 -> And in elderly diabetic patients, this is
a common picture. And in those circumstances,
272.939 -> heart attacks are frequently missed. A heart
attack is sadly still a very, very common
278.97 -> condition. It's one of the commonest causes
of death in the United Kingdom at this stage.
283.9 -> There are 200,000 heart attacks each year
and about 66,000 patients die from a
291.4 -> heart attack every year, and maybe 22,000
of those are under the age of 75. So, despite
298.59 -> a lot of the progress we've got for the treatment
of heart attack which involves opening the
303.069 -> artery very quickly using balloons and metal
tubes called stents, despite all of this,
309.039 -> sadly there are still a lot of people who
die from heart attacks. And so, detecting
313.24 -> coronary disease and giving the prevention
that will help reduce the incidence of heart
318.78 -> attacks is probably one of the most crucial
things we do as cardiologists.
325.82 -> There are two main aspect of the treatment
of coronary artery disease. The first is the
329.87 -> use of medication to reduce the risk of a
heart attack. And that would be aspirin, the
335.22 -> use of a tablet called Astatine which lowers
cholesterol, and a Beta Blocker tablet which
339.52 -> protects the heart. The next treatment of
coronary artery disease is to open up narrowings
345.06 -> using a balloon and a metal tube called a
stent. That's a procedure which I perform
350.139 -> via the radial artery which is the pulse at
the wrist. From there, passing a tube up to
354.71 -> the heart to open up the artery and put in
this metal scaffold which helps the blood
359.599 -> flow down the heart arteries to relieve all
of the symptoms. That's treatment for angina,
364.48 -> but also an emergency treatment for patients
who are having a heart attack.
Source: https://www.youtube.com/watch?v=3SOUiaAIRhM