Cardiac chest pain

[Milkfairy]

Many of us are unsure whether the sensations we feel in our bodies are heart related.

This is a guide that might help.

If in any doubt you should always seek medical advice.

[Red18]

Thankyou. You incredibly knowledgeable

[Milkfairy Heart Star]

Here's the reference

ahajournals.org/doi/10.1161...

[Reikimaster21 in reply to Milkfairy]

good to see you again Milk Fairy. Excellent article, especially take homes. Hope all is as well as can be with you

[Hidden]

thank you as always helpful. I keep questioning my pain maybe as I am still in denial / disbelief- the above clearly shows I am in the deep red without a shadow of a doubt. Knowledge is good.

[Gussy121]

thanks for the information very helpful

[chaz59]

so very helpful Milkfairy , I have not been on here for a while , but always reading the posts …. Since last on here i had a heart attack and another stent…. No 2 , i am looking to go back to work next week but am very mindful of every twinge and mentally scared , just in case …. I think you know what I mean , have a good day 👍

[Hidden]

Now that is one simple, clear chart, that I have sent to friends and family { beats an early Christmas card ! } thank you

[Wooodsie]

Thank you heart star 💫💟

[Ninjanoo]

Hope you are doing OK.

Incredibly useful and informative as always - thank you for posting and sharing. 😊

[IvyNoidea]

tbank you so much for that concise, easy-to-understand guide

[JulianM]

It's a really interesting chart but, from another perspective, quite worrying.

The descriptions on the right side of the diagram include several major symptoms of aortic dissection, which is every bit as serious as cardiac ischaemia.

Aortic dissection survivors often report extreme pain of sudden onset, like being stabbed, torn, with the pain shifting from one place, e.g. chest, to others such as the back, the neck, or other parts of the body, and sometimes subsiding.

However, the emergency doesn't go away with the pain - and misdiagnosis kills people.

The full paper does discuss acute aortic emergencies but suggests they could be picked up with transthoracic echo. This is not great advice: the only reliable way to rule out dissection is early access to CT.

The flow charts in these guidelines made my spirit sink: they are way too complex, IMHO, for where they are most needed - which is for paramedics and ER triage staff.

For a model of what is really needed, and further information on this issue, take a look at the Think Aorta campaign website, aimed at - and endorsed by professional organisations of - radiology and emergency medicine.

thinkaorta.net

[Milkfairy Heart Star in reply to JulianM]

The chart and article are recent professional guidelines.

"Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines"

Maybe contact the Chair of the committee who developed the guidelines, Prof Martha Gulati with your concerns?

[JulianM in reply to Milkfairy]

Thanks for that suggestion, I'll ask the people I know in the aortic dissection charities how best to take it forwards.

[Milkfairy Heart Star in reply to JulianM]

I'll see if I can find her latest email and message it to you.

[Heyjude31]

Really helpful, thanks so much. Judi

[Kswinster]

this is really useful thank you

[FindingCaradoc]

Thanks that’s really helpful-I have had - and continue to experience - vague intermittent chest discomfort/pain since an NSTEMI in April since which I have had a catheter ablation for AF - both GP snd Cardiologist are not concerned

[Dawnmarie78]

This is extremely helpful thankyou for sharing 😊

[ocnnll]

thanks so much for posting this I get very worried 😟 this makes it easier to understand

[Quiltingqueen]

Thamnk you for this information. I still get chest pains since my Minoca in 2021. This is helpful

[Fullofheart]

interesting stuff. Thanks!

[fishonabike]

A useful guide - but the chart omits any reference to the "additional" symptoms experienced more often by women who make up 50% 0f the population.

From the same guidelines in section 2.1.1: "Women may also present with accompanying symptoms (eg, nausea, fatigue, and shortness of breath) more often than men" and "Traditional risk score tools and physician assessments often underestimate risk in women and misclassify them as having nonischemic chest pain"

Women with cardiac-related chest pain are more likely to be misdiagnosed than men with the same or less serious symptoms

[Milkfairy Heart Star in reply to fishonabike]

As a woman living with an often overlooked and undiagnosed type of angina, I agree healthcare professionals and women themselves often ignore their heart related chest pain.

However, women do experience chest pain when having a heart attack . It is suggested that their chestpain maybe more predictive of myocardial ischaemia. It seems as soon as women start declaring their additional symptoms these drown out the symptoms of chest pain.

This is from research by Prof Nick Mills who has researched the use of high sensitivity troponins in the detection of heart attacks.

"Typical symptoms are more common and have greater predictive value in women than in men with myocardial infarction whether or not they are diagnosed using sex‐specific criteria."

ahajournals.org/doi/10.1161...

[Healthyheart1]

Thanks Milkfairy, I would have found that very useful in my early days of angina pains. I'll keep this slide as a reference point. Thanks SheenaSheena

[richard_jw]

Good chart, milkfairy.

Here is one which defines the sort of pain I get with angina. I don't know if it's typical of that which others get. The pain I get is almost always on the left side

Pain I get which I attribute to angina.

[Milkfairy Heart Star in reply to richard_jw]

That is where I feel my angina too.

I also have pain my upper left back near my shoulder blade.

[chaz59 in reply to richard_jw]

I to am the same as yourself , all left side ….. not very nice .

[SJ1000]

Really useful info. Thank you. I’m just back from 11 hours in A&E following a sudden attack of burning pain across my torso and both arms, the attached diagram is really very helpful and would have calmed me enough to take yet more pressure off the NHS. Thanks again for sharing.

[Handel]

Brilliant. Than you so much for making things much clearer. I hope you're doing well.

Lots of love. Jan xxx

[Etblue]

lovely to hear your words of wisdom. Hope you are well...

[NYA2019]

I know this is about chest pain but other symptoms away from chest pain could include chronic snoring/sleep apnoea and frequent migraines. I suffered with both and not had either since my heart attack in January 2019!

[Sewing19]

Thanks for this chart. It’s so useful. It confirms I need to phone the doctor today as I’m in the gold zone. I’ve been in denial. ❤️

[Milkfairy Heart Star in reply to Sewing19]

I hope everything is okay?

[Sewing19]

Thanks me too. I’m seeing my GP at 11.30 today 🤞🤞🤞

[Sewing19]

My GP is treating me for Angina. ECG, BP, troponin all ok. She’s referred me back to cardiology too. It was a bit of a surprise as I foolishly thought that after a triple bypass this wouldn’t happen, but there are more than 3 arteries in the heart. so ………. 🙈❤️

[Milkfairy Heart Star in reply to Sewing19]

I am sorry to hear that. However better to have the potential problem identified sooner rather than later

I hope your wait to see a Cardiologist isn't too long.

[Sewing19]

I bumped into a GP who I used to work with before I retired and he says I could have another artery with a blockage. When I had my triple bypass there was talk about it being a quad so I wonder ? Thank you x