“Doctor, I feel like a fist is going through my heart”... it's an expression we hear a lot.

Several possible causes

Not all thoracic pains are necessarily related to the heart.



Often, we do not find "the" cause

The majority of chest pains often remain without identifiable causes. We must make sure that the heart is not the source of this pain.

If you have thoracic discomfort, and it worries you, speak to a doctor.


What is angina 

The word angina is often used to describe heart-related chest pain.

By definition; angina means pain. However, this pain can originate from different sources.


Fot a better understanding

Let's see why the heart muscle could be the cause of chest discomfort, vulgarly called angina.


The heart needs oxygen

The heart is a muscle. It feeds on oxygen to function. Oxygen distribution is provided by red blood cells.

The pipes used to supply the heart with blood are called the right and left coronary arteries.


Consequence of a physical effort on the heart

When we make an effort, the heart accelerates the circulation to the organs concerned. Its work will be increased with as the demand for oxygen is more important.


Balance "supply and demand" of oxygen required

Everything works perfectly as long as the heart’s oxygen demand balances with its contribution.




The cardiac muscle suffers when the demand for oxygen isn’t adequately supported or when the oxygen isn’t satisfactorily delivered either by a significant lack of red blood cells or because of clogged vessels.


Imbalance brings cardiac "suffering"

This imbalance causes heart muscle damage that can cause symptoms such as chest pain and severe shortness of breath.

For these reasons, the health professional looks for a link between chest discomfort and effort. He checks "how is the heart going?”with these questions.


Silent "suffering" 

To complicate the explanations for heart-related chest pain, some patients often diabetic or older patients do not experience any discomfort or chest pain. They will rather have significant shortness of breath during effort.


"Classic" presentation of angina

From person to person, the symptoms of heart pain vary widely.

The classic presentation is a pain in the center of the chest, with heaviness and numbness of the left arm and short breath.

Several combinations of pain are possible and can be located in the chest, back, left arm,sometimes right arm, shoulders and even in the jaw.


Chest discomfort, with effort, relieved by rest and reproducible

What is important to remember is that the heart pain or "angina" is a discomfort located in the upper body and that it occurs when an effort is made, it is quickly relieved by rest and it is present again with new efforts of the same intensity.

This pain is then very suspicious of a cardiac cause.


Take the example of Mr. Leclerc

He is a 60-year-old man with chest discomfort when walks up the hill near his home to go to the convenience store. Each time, it's the same thing. He must stop for a moment before continuing his walk.

In summary, M Leclerc has pain in the upper body, relieved quickly by a rest period of less than 5 minutes, and it starts over with similar efforts.  

These are classic heart pains, but why the feeling of pain or discomfort?


Why the feeling of discomfort or pain

Walking, especially climbing a hill, has the effect of increasing heart rate and blood pressure.

It is a normal response to physical effort and circulation increases in the muscles in the legs. The heart, normally, is quite capable of responding to this demand.

However, if there are obstructions in the coronary arteries that usually feed the heart, the delivery of oxygen is not done properly.

The supply of oxygen will be insufficient to meet the needs of the heart that faces additional demand (climbing a hill).

The resulting heart muscle suffering then causes these discomforts.

The rest period reduces heart rate and blood pressure. This restores the balance between oxygen supply and demand. The discomfort is then relieved.


Why nitroglycerin helps to relieve angina

Nitroglycerin acts on the walls of the coronary arteries and causes their dilation.

If the origin of the discomfort is a consequence of a clogged vessel, the induced dilation leads to a larger diameter of the artery, compensates the narrowness of the vessel and improves the passage of blood.


Pain in the left arm or jaw

Why a lack of oxygen in the heart would often causes pain in the left arm or in the jaw?

It is the nerve fibers that send the sensation of pain to the brain. To do so, a few steps are necessary.

These fibers are multiple and very particular. They originate in the heart muscle and move to the spine.

From there, they connect to the network of the spinal cord to inform the brain.

In the marrow, the heart nerve fibers connect to the same level as cells that transmit pain information from the left arm, back and jaw.

To visualize these different connections, imagine this nerve of pain as an electrical wire that connects to a multiple power bar where other electrical wires of other appliances come to connect.

Since the stimulation comes from this intersection where several painful fibers converge, it will be difficult for the brain to distinguish where the pain actually comes from.


The person who has an angina crisis or a heart attack will feel that the pain comes from the chest, the left arm, the back, the jaw or many of these places at the same time.

We will speak here of pain referred to the arms, back and jaw.

Each person being different, it is not everyone who will present these pains.


Already, with the description of the discomfort, the diagnosis is narrowed in

The medical diagnosis of angina is made by questioning the patient about his chest pain.


Possible examinations to help diagnosis

Some medical examinations are also used, such as the resting electrocardiogram (resting ECG) and the exercise electrocardiogram (treadmill examination).

Sometimes the information obtained is insufficient to confirm a diagnosis, or the cause of the pain. The doctor then requests more sophisticated examinations such as an exercise echocardiogram or the equivalent, or a nuclear medicine exam such as myocardial scintigraphy during effort or persantin.

Sometimes coronary angiography is required to clarify the diagnosis. This may be the situation where the pains are frequent and affect the patient's activities and the examinations are inconclusive.


Coronary disease

If the diagnosis confirms that chest discomfort is related to a problem in the arteries of the heart, it is called coronary heart disease.


Stable or unstable

The diagnosis of coronary artery disease will be described as stable or unstable.

Stable coronary heart disease describes chronic symptoms of chest discomfort during effort, relieved quickly by rest and repetitive, that is to say, they are predictable for a similar degree of activity.

Unstable coronary artery disease causes symptoms of thoracic discomfort again, or symptoms of progressive chest discomfort, that is to say, they are more and more present during efforts of less and less intensity.


Treatment according to the type of coronary heart disease

Treatment depends on the type of coronary heart disease identified.


How to reduce the risk of harmful events

The doctor can advise you on the actions to take to reduce the risk of dangerous episodes related to coronary artery disease.

These actions include quitting smoking, weight loss, a balanced diet, and regular exercise, control of bad cholesterol and control of blood pressure.

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