CASE STUDY : THE CHEST PAIN PARADOX
#ChestPain #Angina #Gastritis #Symptoms #Diagnosis #Treatment #Endoscopy #ECG #HeartDisease #DigestiveHealth
Mr. Ashok ( name changed ) is a 56-year-old male with a history of hypertension and diabetes, and occasional smoking and drinking habits. One night after having dinner, he experienced chest pain. He immediately took antacids and ENO, but unfortunately, the pain did not subside. Concerned about her husband's condition, his wife contacted me, and I advised them to go to the nearby cardiac hospital immediately. Mr. Ashok was reluctant and said that he had such symptoms previously also, that it was gastric pain due to heavy meal and he will get better with time. But, I insisted and finally convinced them .
Upon arrival at the hospital, Mr. Ashok was immediately evaluated by the emergency staff. The cardiology doctor ordered an urgent electrocardiogram (ECG) test, which was performed promptly. The ECG test, however, came back as normal, but I was not convinced and decided to order further tests.
On my suggestion, the duty doctor advised Mr. Ashok to undergo cardiac enzyme and troponin I tests, which were promptly performed. The results showed that he had a positive troponin I test, indicating that he had a mild heart attack.
The medical team immediately started treatment for Mr. Ashok, including medications to manage his hypertension and diabetes, and started him on aspirin and other medications to reduce his risk of further heart damage. His coronary Angiography test was done which revealed double vessel disease (DVD) and subsequently he was subjected to coronary Angioplasty with stents. Mr. Ashok was monitored closely in the hospital for several days, and his condition gradually improved.
He was eventually discharged from the hospital with medications to manage his blood pressure, diabetes, and to reduce the risk of future heart attacks. Mr. Ashok was also advised to make lifestyle changes, including quitting smoking and reducing alcohol consumption, and making changes to his diet and exercise regimen.
Definition of Chest Pain
Chest pain can be defined as a localized or diffuse sensation of discomfort, pressure, or squeezing located in the thoracic region.
Chest pain dilemma : Is it Angina or Gastritis?
Differentiating between the pain of gastritis and angina can be challenging, as they can have similar symptoms. However, there are some key differences that can help in distinguishing the two:
Location of pain: The pain of gastritis is typically located in the upper abdomen, while the pain of angina is usually felt in the chest or arm.
Type of pain: The pain of gastritis is often described as a burning or gnawing sensation, while the pain of angina is usually described as a pressure or squeezing sensation.
Triggers: Gastritis pain can be triggered by eating certain foods or taking certain medications, while angina pain is often triggered by physical exertion or emotional stress.
If the pain persists despite taking antacids and PPI, it is important to seek medical attention. In general, the following checklist can help in determining whether hospital admission is necessary:
1. Severity of pain: If the pain is severe and/or worsening, hospital admission may be necessary.
2. Duration of pain: If the pain has been persistent for several hours or days, hospital admission may be necessary.
3. Other symptoms: If you experience additional symptoms such as shortness of breath, dizziness, or nausea, hospital admission may be necessary.
If the ECG is normal, additional tests may be required to determine the cause of the pain. These tests may include blood tests to check for markers of coronary ischemia , an upper endoscopy to evaluate the stomach and esophagus, or a stress test to evaluate the heart. There are several studies and scoring systems that have been developed to help distinguish between the pain of gastritis and angina. One example is the Goldman criteria, which evaluates the likelihood of coronary artery disease based on several clinical factors such as age, sex, and type of pain. However, these scoring systems are not always accurate and should be used in conjunction with other diagnostic tests. Overall, if you are experiencing persistent or worsening pain despite taking antacids and PPI, it is important to seek medical attention to determine the underlying cause and appropriate treatment.
Angina: Symptoms and Causes
Angina is a medical condition that results in chest pain, discomfort, and tightness. It occurs when the heart muscles do not receive enough oxygen-rich blood due to narrowing of the arteries or blockage in the blood vessels.
The most common symptom of angina is :
pain or pressure sensation in the chest area that can also spread to other parts of the body like arms and shoulders
shortness of breath,
sweating,
dizziness,
nausea or vomiting.
The causes of angina vary according to the different types.
1. Stable angina usually results from
physical exertion
emotional stress
exposure to cold temperatures
2. Variant ( Prinzmetal ) angina occurs due to spasms in coronary arteries.
3. Unstable angina is considered as an emergency medical condition and can result from atherosclerosis plaque buildup within arterial walls leading to reduced blood flow through coronary arteries.
Risk factors for developing angina include high blood pressure, high cholesterol levels, smoking, diabetes and obesity.
Gastritis: Symptoms and Causes
Gastritis is a common condition that affects the stomach lining, causing inflammation and irritation.
This condition can be caused by several factors, such as :
alcohol consumption,
smoking,
medication overuse,
bacterial infections like Helicobacter pylori (H. pylori),
stress.
Symptoms of gastritis may vary from individual to individual but can include :
stomach pain or discomfort,
bloating,
nausea or vomiting,
loss of appetite or weight loss.
Diagnosis: Tests to Determine Cause
When a patient reports chest pain, it is important for healthcare professionals to determine the cause of the discomfort. Chest pain can be caused by a variety of factors including angina or gastritis. To determine the cause of chest pain, doctors may conduct several tests.
One common test for diagnosing angina is an electrocardiogram (ECG). This test measures the heart's electrical activity and can identify any abnormalities that may indicate reduced blood flow to the heart muscle. Doctors may also perform a stress test where patients are asked to exercise while their heart rate and blood pressure are monitored.
For gastritis, doctors may request an upper gastrointestinal endoscopy. During this procedure, a thin tube with a camera on the end is inserted into the esophagus to examine any inflammation or irritation in the stomach lining. Additionally, blood tests may be conducted to assess levels of digestive enzymes and other markers associated with gastric disorders.
Treatment Considerations
Once a diagnosis has been made, treatment considerations can vary depending on the severity of symptoms and underlying medical conditions. For patients with angina, lifestyle modifications such as exercise and dietary changes may be recommended in addition to medications like nitroglycerin or beta blockers. In cases of severe angina, invasive procedures like angioplasty or coronary artery bypass surgery may be necessary.
Patients with gastritis may benefit from antacids or proton pump inhibitors to reduce stomach acid production while avoiding foods that trigger symptoms.
Overall, early recognition and proper management of chest pain are essential for preventing long-term complications and improving quality of life for patients with either angina or gastritis.
Lifestyle Changes to prevent Anginal pain
Regular exercise is another important lifestyle change that can help alleviate chest pain symptoms. Staying active helps maintain a healthy weight, reduces stress, improves blood flow, and strengthens the heart muscles. Additionally, practicing relaxation techniques such as deep breathing exercises, meditation or yoga can help manage stress levels which are often associated with chest discomfort.
Conclusion
Mr. Ashok's case highlights the importance of prompt medical attention in cases of chest pain, particularly in individuals with risk factors for heart disease such as hypertension, diabetes, and smoking. The normal ECG results were not sufficient to rule out the possibility of a heart attack, and further tests were necessary to confirm the diagnosis.
If you are experiencing chest pain it is essential to consult with a physician immediately. Early diagnosis and prompt treatment can help prevent serious complications and improve overall health outcomes.
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