Chest pain may be angina

DEAR DR. ROACH: I get pressure in the centre of my chest, behind the breastbone, after walking at a moderate speed or other moderate exercise, and sometimes with emotional excitement.

The pressure is relieved with stopping the exercise. I have noticed that I feel better if I have a snack between meals. Do you have any suggestions of the possible cause?

ANSWER: Although you haven’t told me your age, this history makes me very concerned for coronary artery disease, blockages in the arteries to your heart.

Angina pectoris, which is Latin for “chest pain,” is not usually perceived as pain. Most people describe a pressure, tightness or discomfort. The fact that it comes on with exercise and is relieved by stopping is highly suggestive — I would get to your doctor right away and ask about getting an evaluation. This may include a stress test.

The more risk factors you have, the more likely these symptoms are to represent heart disease. Risk factors including being male, of older age, history of smoking, high blood pressure, unfavourable cholesterol panel, family history of heart attack or blockages, being overweight (especially around the middle), poor diet and lack of exercise.

Getting better with a snack is not a usual feature of heart disease, and it is possible that your symptoms are related to a gastrointestinal problem. However, it’s a physician’s job to consider all the data and to carefully consider the most dangerous possibilities. If you have several risk factors, most physicians hearing your symptoms would get you evaluated right away, or send you to an expert to do so.

Email ToYourGoodHealth@med.cornell.edu .