Frequently Asked Questions about Chest Pain

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Is chest pain the only important symptom of a myocardial infarction?

No, other symptoms are also important. Sometimes patients do not consult because they have no pain, but it is possible to have an infarction without pain, particularly in those over 60 years-old, diabetics, and women. 

For this reason, it is important to pay attention to any of the symptoms that may be presented in a myocardial infarction: 

- Pain, pressure, discomfort, in the middle of the chest.

- Pain, discomfort, in other parts of the upper body such as the arms (can be both arms, not only in the left), back, neck, jaw or stomach.

- Shortness of breath.

- Nausea, vomiting, burping, acidity.

- Sweating, pallor.

- Sensation of palpitations, noting an irregular heart rhythm. 

- Feeling of lightheadedness or even loss of consciousness

- All these symptoms are important, particularly if they are continuous or are repeated. 

- If there are any doubts, call emergencies (112) and do not go the hospital by yourself.

Is it only a myocardial infarction that presents as chest pain?

No. Chest pain can be a sign of many diseases with varying degrees of severity, such as: 

• Inflammation of the membrane that surrounds the heart: pericarditis.

• Muscle pain.

• Arthritis.

• Herpes zoster.

• Gastrointestinal problems, such as gastroesophageal reflux.

• Problems that affect the lungs such as pneumonia.

• Psychological problems such as anxiety or panic attack.

• Weakness of the aortic wall (aortic dissection).

What is a myocardial infarction?

It is what happens when one of the arteries that supply blood to the heart (coronary arteries) is obstructed. This means that the part of the heart that receives the blood from this artery stops receiving it and causes damage to the heart cells (since they do not receive the oxygen and glucose that is transported in the blood for proper cell functioning), as such that if the obstruction is not resolved these cells die. 

If I have a myocardial infarction, what will happen to me in the Emergency Department?

An electrocardiogram will be performed as quickly as possible, after which they will take blood, and start treatment with drugs, generally aspirin in order to prevent more clots forming, as well as intravenous nitroglycerin, and if you have a lot of pain it is possible that they might administer morphine. There are several types of infarction depending what is seen on the electrocardiogram. The two main types are an ST elevation myocardial infarction and a non-ST elevation myocardial infarction, and the treatment will depend on which type you have. 
In the first case, to unblock the heart artery that is blocked is the main priority, generally by performing a cardiac catheterization. 
In the second case, a catheterization can be performed to unblock the artery (which in this case is partially blocked). This does not have to be done immediately, and is sometimes performed in the 24-48 hours following your arrival in the hospital. Or the non-ST elevation myocardial infarction can be treated conservatively with drugs initially, and a stress test performed during the hospital admission. 

They have to perform a catheterization on me; is it a complicated surgery?

Catheterization or coronary angiography is not a surgical intervention, it is a diagnostic test, and is often also a treatment when one or several stents are inserted during the procedure. 

The is a metal mesh in the form of a tube that is implanted with the aim of unblocking the blocked artery in order to keep the lumen open and improve the blood flow to the heart muscle. The procedure is performed by means of a puncture and insertion of a catheter, generally in the radial artery of the right arm or via the right femoral artery, if it is not possible to pass it through the radial artery. A local anaesthetic is given in the puncture area. 
Although it is not a surgical procedure, it requires not ingesting solid foods and/or liquids at least 8 hours before the procedure, as during the test a substance called contrast is introduced that allows the obstruction of the vessels to be visualized. Two-three hours after the procedure, you can start taking liquids, and it is also recommended in order to eliminate the contrast via the urine. If there is no vomiting, you can progress to eating foods. 
If the catheterization is performed through the radial artery, the arm must be rested for 4 hours, and it is recommended not to lift weights with this arm for the next 24-48h. If the procedure is performed through the femoral artery, absolute rest must be maintained for 6h, and relative rest for 24h (you can sit up, but not walk).

What are the most serious complications of a myocardial infarction?

The presence of an arrhythmia called ventricular fibrillation and that presents as a cardiac arrest. For this reason, during the acute phase of the infarction the patient has to be fully monitored all of the time and supervised in order to be able to detect these complications as soon as possible and treat them immediately.

What is ventricular fibrillation?

In the context of an infarction, it is produced as a result of the destruction of heart cells. People who have this lose consciousness and have no pulse or heartbeat. They have to be treated immediately by means of defibrillation, which consists in the administration of an electrical discharge to the heart in an attempt to achieve a normal heart beat. 

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Substantiated information by:

Beatriz López
Emilia Vázquez

Published: 20 February 2018
Updated: 20 February 2018

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