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Chest Pain

Coronary artery disease (ischemic heart disease)

Coronary artery (cardiovascular) is a disease that artery becomes narrow due to arteriosclerosis so that the heart does not receive enough oxygen and nutrients, resulting in chest pain and dyspnea. This includes angina or acute myocardial infarction.

Angina

There are several blood vessels on the surface of the heart that supply oxygen and nutrients constantly to the exercising heart muscle, which are called coronary arteries. When a part of the coronary artery is narrowed and blood supply is disrupted, pain, pressure and squeezing feeling occurs, which is called angina.

Cause
Common reason for the narrowing of the coronary artery is accumulation of fat and calcium, which are mainly cholesterol, in the blood vessel lumen, forming a hardened atherosclerotic plaque, which narrows the blood vessels. Hypertension, smoking, diabetes, obesity, and hyperlipidemia are major risk factors for arteriosclerosis. Other factors include mental stress, impatient and competitive personality, and lack of exercise.

Symptom

Angina can be classified into three types according to severity and pattern of symptoms. First, stable angina appears only when you are doing some activity (such as climbing a hill, running flat surface, climbing a mountain) rather than resting. Unstable angina is a condition in which angina occurs with less activity, such as taking a shower or walking on flat surface, or chest pain occurs during resting, and the frequency of myocardial infarction is higher than that of stable angina. Lastly, variant angina occurs predominantly in young people in their 30s and 40s and is easily misdiagnosed as neurogenic chest pain. Transient seizures have recently been shown to be rarely caused by spasm of the coronary arteries, even without stenosis of the coronary arteries.
Often, the symptoms of angina include painful squeezing or tightness in the chest when do brisk walking, climbing hills, doing hard work or going outside suddenly from warm space on a cold day. Along with this, pain may radiate to shoulders, arms or neck, and there may be symptoms such as compressing the neck or toothache. If the pain is severe, it may be accompanied by symptoms, such as sweating, shortness of breath, wheezing and palpitation. On the other hand, it may appear only as a symptom of shortness of breath without pain in the elderly or diabetic patients. Angina attack usually occurs followed by overeating, chilling, excitement, smoking cigarettes, alcohol or excessive exercise. This attack usually does not last more than 15 minutes, and when stopped, pain disappears completely.

Treatment
Coronary artery diseases, including angina, require professional medical treatment immediately after the onset. First, non-invasive tests, such as electrocardiography, exercise stress test, nuclear medicine test, or coronary angiography can be performed to check the condition of blood vessels after taking detailed medical history and consultation. Depending on the extent of the lesion, prognosis can be determined and treatment plan can be established. Treatment methods include administration of coronary artery dilator to eliminate symptoms, coronary intervention (stent insertion) or surgical treatment of coronary artery bypass surgery, and appropriate one will be decided depending on patient's condition and severity of disease.

Prevention and Rehabilitation
The most important thing is prevention and prevention of recurrence. In the case of hypertension, active diet modification and drug therapy are performed to maintain proper blood pressure. In case of high cholesterol (hyperlipidemia), diet modification and if necessary, medication treatment should be done to lower the cholesterol. Smoking is not allowed. If you are overweight, you should lose weight and exercise regularly.

Acute myocardial infarction.

Myocardial infarction occurs when blood flow of coronary artery is suddenly blocked by blood clots, causing necrosis of the heart muscle and contraction problem, and this is also called heart attack. Myocardial necrosis causes severe chest pain and arrhythmia due to electrical instability of the myocardium. In particular, when ventricular fibrillation, which is a ventricular arrhythmia, is observed, ventricular contractility is lost and heart cannot supply oxygen and nutrients to the brain. If it does not recover within 5 minutes, permanent brain function damage or death can occur.

Cause
Acute myocardial infarction is caused by sudden clot formation by arteriosclerosis of the coronary artery inner wall (atherosclerotic plaque) in over 90% of patients, leading to blockage of the coronary artery. Major risk factors for arteriosclerosis include hypertension, smoking, diabetes, obesity and hyperlipidemia. Other factors include mental stress, impatient and competitive personality, and lack of exercise.

Symptom

• Severe pressure in center of the chest that lasts longer than 30 minutes
• Pain radiating to shoulders, neck, chin, arms or back
• Dizziness, fainting, cold sweat or shortness of breath or nausea

 

Characteristic

• Intensity of pain is high
• Long duration.
• It is not effective with medicine or resting.
• If left untreated, it may cause permanent damage to heart muscle to survived patients.

 

Diagnosis
The initial diagnosis is made by clinical symptoms and changes in the EKG. Confirmation requires increase of cardiac enzyme level in blood test and usually takes several hours.

Treatment
It is important to restore blood circulation therapy by re-opening blocked blood vessel. Early reperfusion can minimize myocardial damage and preserve myocardial contractility. Reperfusion therapy should begin within 4 to 6 hours from first onset of chest pain for the best results.
For reperfusion therapy, thrombolytic agent injection and coronary stent implantation are the basis of treatment. Full recovery requires several weeks for myocardium healing. In mild myocardial infarction, return to work is possible in 2 weeks, but moderate myocardial infarction should require 4 weeks and severe myocardial infarction will require about 6 weeks of rest.

Prevention
Aspirin, beta-blockers, and statins are medications that help prevent re-infarction and prolong patient survival, and should be taken continuously unless contraindicated. Smoking cessation, weight loss, diet, blood pressure control, sugar control, cholesterol control and proper exercise can improve the quality of life and prolong life expectancy. In addition, regular cardiac test can prevent re-infarction and predict patient's risk.

Aortic aneurysm

It is a disease that blood vessel wall is swollen and transformed into a balloon-like shape, and when any part of the aorta becomes larger than 1.5 times normal, it is called aortic aneurysm. About 75% occurs in the abdomen and 25% occurs in thoracic aorta.

Cause
Atherosclerosis : Weakened area due to degeneration of the arterial wall gets loosened because it cannot withstand blood pressure.

Symptom
It is usually found accidentally through chest computed tomography (CT) or abdominal ultrasound, and often has no symptoms. However, compression of surrounding organs can cause chest discomfort, chest pain or abdominal pain. Abdominal aortic aneurysms are sometimes diagnosed by palpating a mass in the abdomen.

Diagnosis
It can be diagnosed through chest abdominal CT, and is particularly useful for small aortic aneurysms that are not subject to surgical resection or post-procedure follow-up.

Treatment
Treatment of aortic aneurysm includes surgery, percutaneous implantation, and medication. If there is no complication due to aortic aneurysms and the size is not large, hypertension and arteriosclerosis drug treatment will be performed and CT will be followed up regularly.
Surgery or percutaneous stent implantation is performed when there are complications from an aortic aneurysm, large size, or progressive expansion.
The surgical method is to excise the aortic aneurysm and replace it with an artificial blood vessel. Percutaneous implantation is performed through the femoral artery. This is performed when the location and shape of the aortic aneurysm is deemed appropriate, and is known to have a shorter hospitalization and recovery period and fewer complications compared to surgery.

Aortic dissection

It is a disease that blood vessel wall is swollen and transformed into a balloon-like shape, and when any part of the aorta becomes larger than 1.5 times normal, it is called aortic aneurysm. About 75% occurs in the abdomen and 25% occurs in thoracic aorta.

Cause
Uncontrolled hypertension is the most important cause accompanied by 80% of all patients. Congenital reason include Marfan syndrome, bicuspid aortic valve or Turner syndrome. It can also be caused by aging process or atherosclerosis.

Symptom
It appears as chest pain, and sudden, irresistible, “tearing” extreme pain occurs in the front of the chest, on the back, or on the stomach.

Diagnosis
Computed tomography (CT) is used as the primary imaging diagnosis.

Treatment
It can be classified into non-invasive treatment or surgical treatment depending on location of aortic dissection and complications. If there is a problem in descending aorta but no complications, progress will be observed as administering medication that stabilizes blood pressure and pulse. If there is a problem in ascending aorta, risk of sudden death due to aorta rupture is high, so surgery is the standard method. In addition, surgery is also needed if there are major organ blood flow disorder, suspected aortic rupture, or congenital factors such as Marfan's syndrome.