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“Is it my heart, doctor?”
Chest pain can be a sign of coronary artery disease, where the arteries supplying blood to the heart itself, have ‘furred up’ and become narrowed.
This results not in chest pain, as such, but in a tight, compressing feeling - angina which is a tight band around the chest that comes on exercise or with a lot of hot and bothered emotion. Coming face to face with a tiger might do it!
In William Blake’s poem, ‘The Tiger ‘ he says- ‘what art could twist the sinews of thy heart?’. He is referring to the tiger’s heart, not the human heart but there is not a lot of difference!
True angina (as it is called) is a tight discomfort that comes predictably on walking a certain distance, at a certain pace. Eat Sunday lunch, go for a walk in the cold and have an argument with a friend while doing so - this is bound to bring it on.
2 Key Points
If it hurts more when you breathe, it is unlikely to be coming from your heart. If it hurts more when you twist your torso around, it is unlikely to be your heart.
True heart pain is commonly central to the front of the chest, although, I have known it affect the neck, back and upper arms.
True heart pain can be ‘atypical’ - coming on at rest. This may occur due to artery spasm, or more likely due to a completely different cause such as gullet spasm.
An ECG at rest may not diagnose it. An exercise ECG and sometimes a 24h ECG are better. None of these is 100% diagnostic (85% at best) so other tests may be required. True angina is made much more likely by the presence of ‘furring’ in the neck arteries. Nearly every case of coronary artery disease will have ‘furring’ in places other than the heart. A heart perfusion scan and coronary arteriogram may be necessary for diagnosis.