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It Could be More Than Indigestion: Chest Pain is a Serious Symptom

March 17, 2017 | By Lisa Schwenk
Published in: Heart, Question Answer

Cath Lab team preparing for a procedure.

Arun Prahash, MD
Arun Prahash, MD

You may think you've never heard of Acute Coronary Syndrome, but you probably know someone who has experienced it—or maybe you've experienced it yourself. Its most common symptom is chest pain.

Chest pain caused by Acute Coronary Syndrome can be sudden, as when it's a heart attack, or unpredictable or get worse even while resting, a condition known as unstable angina. Chest pain is commonly caused by narrowing of blood vessels that supply blood and oxygen to the heart.

“Not all incidents of chest pain are from heart attacks that require emergency procedure, but in general they should all be taken seriously," says Arun Prahash, MD, a cardiologist with Augusta Health Cardiology. "We need to determine what is causing these symptoms, and do what we can to prevent the need for an emergency procedure in the future."

When a patient is experiencing symptoms such as chest pain or other symptoms of heart disease, he or she would often consult a cardiologist. The doctor will take a medical history and will usually run some non-invasive tests like an electrocardiogram (EKG) or perhaps an echocardiogram, a type of cardiac ultrasound, and a stress test to screen for possible coronary artery disease. If necessary, the cardiologist may recommend a more conclusive test. "We may also do a cardiac catheterization, or angiogram, to see the heart arteries," explains Dr. Prahash.

During a cardiac catheterization, a thin tube called a "catheter" is inserted through an artery in the wrist or the leg and guided up into the heart. Then the tube is injected with a contrast containing iodine, and the cardiologist can watch the flow of the dye to discover any blockages in the heart on a cine X-ray screen. A cardiac catheterization is an invasive procedure because an instrument has entered the patient's body through an incision. These days most of these catheterizations are done through the wrist instead of the traditional groin approach because of the advantage of less risk of bleeding and complications.

"The cardiac catheterization is like a moving image road map," adds Dr. Prahash. "From what we see in this map, we may decide to treat the blockage with medication, or we may decide to use an intervention to open the artery with a balloon that is inflated, and then deflated. This is an angioplasty, which is usually followed by inserting a wire mesh tube, called a stent, to keep the blood flow open. So while the catheterization is the road map, the stent is delivering the device exactly where it is needed."

And while cardiac catheterizations, balloon surgeries and stents can open arteries that are closing and putting patients at risk for heart attacks, Dr. Prahash believes the most important step that can be taken by the patient is a lifestyle change—one that includes taking actual steps!

"I like to tell people to replace their screen time with green time," he says. "It's very important to increase physical activity, to just get up and move. It does not have to be complicated or expensive—simply walking 15 to 30 minutes each day will improve your condition. Other lifestyle choices, like eating a healthy diet and not smoking are also key to reducing risk."

A recommended website for those trying to reduce risk and learn about heart disease is Cardiosmart.org, a service of the American College of Cardiology. It can be used to track activity and health status and receive educational information.

"Patients should also take preventive care seriously," adds Dr. Prahash. "That means having routine conversations with their primary care physician to make sure they are doing what they should be doing to stay healthy. A good partnership with your doctors is a good way to improve your health."

Arun Prahash, MD, is a cardiologist at Augusta Health Cardiology. He completed his residency at the University of Minnesota and then fellowships in Cardiovascular Disease and Interventional Cardiology at Baylor College of Medicine in Houston, Texas. He is Board-Certified in Cardiovascular Disease and Interventional Cardiology. He has practiced cardiology in central Virginia since 2007, and is excited to join Augusta Health Cardiology and building a program with his colleagues that offers new services and improves the lives of his patients.