Chest Pain or angina is an important symptom of Heart Attack. Chest pain will be due to other causes also, such as indigestion, gas trouble and bronchitis/severe cold spread in the chest. We must be alert and find out the real reason for the chest pain and take immediate medical treatment when it is Heart attack. The main causes and risk factors of Heart Disease and Heart attack are:-

• family history,
• high blood pressure,
• diabetes,
• high cholesterol,
• smoking and
• excessive drinking of alcoholic drinks

We cannot do anything for the family history, that is, if our parents and/or close relatives have had Heart Disease and had heart attacks.
For the other five causes and risk factors, we can take preventive and remedial measures.

The chest pain due to heart attack is angina which will be felt as:-

• pressure,
• heaviness,
• tightening,
• squeezing, or
• aching across the chest,

particularly behind the breastbone, which will spread to neck, jaws, shoulders, and arms. The person having heart attack will suffer:-

• indigestion,
• heartburn,
• weakness/fatigue,
• sweating,
• nausea/vomiting,
• cramping, and
• shortness of breath.
  

Angina pain will normally occur due to:-

• exertion/strain,
• severe emotional stress or
• after a heavy meal.

During these periods, the heart muscles will demand more blood oxygen than the narrowed coronary arteries can deliver, and this is called demand angina. Angina pain will last for a duration of 1 to 15 minutes and will be relieved by taking rest and/ or by placing a nitroglycerin tablet under the tongue. Nitroglycerin will relaxe the blood vessels and lower blood pressure. Both rest and nitroglycerin will decrease the demand of the heart muscles for more of oxygen, thus relieving angina pain.

Angina pain is of two types:-
1) stable angina and
2) unstable angina.

Stable angina is the most common type of angina. People with stable angina will have angina symptoms on a regular basis and the symptoms will be predictable. Some people will get angina pain when they walk after eating a meal, or when they rush to catch a bus or train and when they climb up a stair case or when they walk in the hot sun. The stable angina pain will be relieved by rest and/or by having nitroglycerin under the tongue. Normally, stable angina will not be a symptom of heart attack.

Unstable angina is less common and more serious. The symptoms will be more severe and less predictable than the stable angina. Moreover, the pain will :-

• be more frequent,
• last longer,
• occur at rest and
• not be relieved by rest and/or keeping nitroglycerin under the tongue, or more number of nitroglycerin tablets than usual will be required. Unstable angina itself is not a heart attack, however unstable angina must be given immediate remedial measures, as unstable angina will be a symptom of heart attack.
• Angina Pain is actually a gift given by God as a warning signal to a heart attack.
  
• Some people will have painless angina, and they will feel some uneasiness in the chest, instead of pain. People of known heart disease with painless angina must be more careful about other symptoms of heart attack.
  

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