CONFUSING CHEST PAIN

My 64-year-old father

82 kgs. He underwent a coronary angiogram in which no blockages were found. However, he continues to experience pain around his chest area and the consulting doctor told us that it could be due to muscle pain. What is causing him the pain?

Chest pain could occur

of multiple causes and only a small percentage of them arise from the heart. However, because heart pain is the most serious one, the dictum is that every chest pain should be treated as coming from the heart, unless and until proved otherwise, but in generic terms, majority of chest pains do not come from the heart and may arise either from the muscles or bones and joints of the chest wall or from the food pipe and the stomach. Even the lung and its covering layers can give rise to chest pain. So, to pin point the cause of pain through remote consultation would be impossible.

Normal coronary arteries on an angiogram rule out blockage in the major arteries of the heart. However, sometimes smaller arteries, which are microscopic and not visible to the naked eye, and therefore are not seen on the angiogram, may have blockages. Also, the inner lining of these blood vessels may be at fault (endothelial dysfunction) and can sometimes lead to sluggish circulation in the micro-circulation of the heart and produce chest pain (called Syndrome X).

However, for all this, you need to consult a cardiologist who can give you a firm answer about the cause of the chest pain and the further treatment that you need to take. This is also decided keeping in mind the risk profile of the individual — whether he has diabetes, hypertension, family history of certain diseases, history of tobacco intake, etc. So I suggest that you consult your cardiologist on this matter.

As an afterthought, I notice that the weight reported is 82 kgs, which is significant obesity and he should make an effort to reduce his weight also, which may help matters tremendously.

Senior Consultant Cardiologist