Twinge, Tightness, or Trouble? Understanding Chest Pain

Insights from Health Talk with Christina Swain, FNP-C

Chest pain can be unsettling, often sending our heads swimming in all the possible causes. Christina Swain, FNP-C, from the Heart & Vascular Center, recently participated in a virtual Health Talk discussing chest pain symptoms, distinguishing between more severe symptoms and less severe symptoms, as well as how the Heart & Vascular Center evaluates these symptoms.

It’s important to understand your chest pain, because it doesn’t always have to do with your heart. Swain mentioned, “It could be gastrointestinal issues, it could include muscular skeletal issues…the obvious things that people think of as problems with your heart doesn’t always mean you’re having blockages in your heart arteries, it could be something else going on with your heart causing your chest pains.”

Less concerning vs. concerning chest pain symptoms:

What exactly does “less concerning” mean? Swain states, “I call this less concerning chest pain because these are more of the characteristics that we think of with what we call atypical chest pain, or chest pain that isn't necessarily anginal in nature. Anginal, meaning it's probably not caused by a blocked heart artery, leading to lack of blood flow through that artery and therefore starving your heart muscle of oxygen.”

Less concerning chest pain symptoms include:

● Descriptors such as sharp, stabbing, sore or throbbing.
● Pain that lasts less than 30 seconds or longer than 12 hours is also viewed as less concerning, consistent pain longer than 12 hours is typically not associated with the heart.
● Aggravators of the pain including bending, movement, breathing, or palpation are also classified with less concerning chest pain symptoms.
● No other symptoms besides pain.
More concerning chest pain symptoms include:
● Characteristics including heaviness, tightness, pressure, fullness, or burning. ●Pain that lasts 5 minutes to a few hours, progressively worsening or stuttering (the pain comes and goes, but is worse each time it returns).
● Aggravators of the pain include exertion, stress or anxiety.
● Symptoms include shortness of breath, nausea, sweating, and radiation of pain.

Swain mentioned, “Remember to always talk with a provider about your chest pain symptoms. Even if you think they are minor. We can help determine causes and guide you through certain testing if needed.”
Serious chest pains may become an emergency. “If you are by yourself and having very concerning symptoms that aren't letting up, definitely call 911. If you have access to baby aspirin, we recommend that you chew baby aspirin while you're waiting and, I know this sounds very hard, but just sit and relax as much as possible, ” Swain added.

Evaluation of concerning chest pain:

If a provider believes that your chest pain is concerning, they will further evaluate with a left heart catheterization. “This allows us to directly visualize your heart arteries and determine if there is an issue with blood flowing through them. And most of the time, if there is, we can fix it during the procedure,” says Swain.

Evaluation of less concerning chest pain:

If a provider believes your chest pain is less concerning, there are still a variety of tests that can be done to further look into your chest pain. One of these tests includes a treadmill stress test, also known as TST or ETT, which is where the patient will walk on a treadmill while they are testing a variety of things including blood pressure, heart rate, breathing, and an electrocardiogram. If the TST comes back abnormal, they will move onto imaging. Nuclear stress testing and stress echoes are tests that involve imaging but also require movement on the treadmill or a medication called Lexiscan.

Nuclear Stress Testing:

● Uses a nuclear tracer that “invades” your heart muscle
● Compare nuclear images at rest and stress
● If nuclear pictures look the same, then blood flow to the muscle should be normal ● Can be done on the treadmill or using a medication called Lexiscan

Stress Echoes (heart ultrasounds):

● Compare heart ultrasound images of your heart at rest versus at a target heart rate based off of your age
● If heart wall motion looks the same, then blood flow to the muscle should be normal
● Can be done with treadmill or using medication called dobutamine

Coronary/cardiac CT scan (CCTA):

Another example of imaging used to assess the heart is a coronary or cardiac CT scan (CCTA). This procedure involves injecting a contrast dye through an IV while capturing precisely timed images of the heart using a CT scanner. To ensure the clearest images,
a medication called Lopressor is administered to temporarily slow the heart rate. By combining the contrast agent, slowed heart rate, and carefully timed imaging, the scan provides detailed views of plaque buildup in the heart's arteries. However, while it can identify the presence of plaque, it does not determine the severity of any blockages.

Calcium Scoring:

Calcium scoring is not typically done for chest pain, but is common for preventative care. Individuals with predetermined risk factors can receive a calcium scoring test to see if they should begin medical therapy to prevent the worsening of coronary artery disease. This type of imaging does not involve contrast fluids or visualize the heart's arteries, but looks for calcification on the heart. The individual is then given a “calcium burden score” and calculates a person's risk of cardiovascular problems based on their age.

While chest pain can be broad and could mean many different things, it’s best to not panic and seek guidance from your healthcare provider. If you have questions or concerns regarding chest pain, visit the Heart and Vascular Center at 336 Deerfield Road, Boone, NC 28607 or call (828) 264-9664.

Watch Christina Swain's Health Talk here