Aside from injuries, the second most common reason adults in the Karachi go to the emergency department is chest pain, and despite the growing prevalence of cardiovascular disease nationwide, more than half of these chest pain visits have non-cardiac causes.

But chest pains, and the possibility of a heart problem, are not to be taken lightly. There can be several reasons a person experiences it, and the likelihood of a cardiac issue hinges mostly on a patient’s risk profile, said Prof Abdul Rasheed Khan on Saturday.

“It can be quite challenging to distinguish between heartburn and heart attack, and we often can’t be certain until we do an evaluation, like an electrocardiogram, also known as an ECG, or a blood test,” said Prof Abdul Rasheed, consultant cardiologist and ex-head of the Department at Abbasi Shaheed Hospital & the Karachi Institute of Heart Diseases, at a public awareness session held in collaboration with Dr Essa Laboratory & Diagnostic Center, DHA, Jami Branch.

“As cardiologists, we are more concerned about chest pain in patients who have risk factors for heart disease, such as high blood pressure, diabetes, kidney disease and being over the age of 60. These conditions all increase risk for coronary artery disease, or blockages in the heart arteries,” he added.

The session was told that if you have chest pain that’s new and severe, or associated with other symptoms like shortness of breath or nausea, these are reasons that you should go to the emergency department. Classically, heart pain is in the center or left side of the chest and it may radiate down the left arm or into the jaw. But not every patient experiences the typical ‘elephant-on-your-chest’ feeling. Sometimes, nausea, shortness of breath or feelings of indigestion are the most prominent symptoms. A lot of times when people are having heart attacks, they just feel really unwell, maybe cold and clammy. They know inherently that something is wrong.

Not all heart-related chest pains are due to blockages in the heart arteries. A condition called pericarditis, which is inflammation around the lining of the heart, can cause chest pain that gets worse with deep breaths or with lying down. Pulmonary embolism, or a blood clot in the lung, can cause shortness of breath, elevated heart rate and chest pain that gets worse with deep breathing.

“Women’s heart attack symptoms may differ. In fact, almost 40 per cent of women who have heart attacks reported experiencing symptoms similar to heartburn or indigestion shortly before their heart attacks.

Heart attacks are more commonly missed in women and usually manifest as nausea and vomiting in women, more so than men if you’re a woman over the age of 50, with other contributing factors such as diabetes or obesity. If you are having chest pain with these kinds of features, you should go to a hospital, yes a hospital, not a clinic, since clinics won’t be equipped to deal with such an emergency. A clinic is an option only when access to a hospital is difficult,” Prof Abdul Rasheed explained.

“Heartburn or gastroesophageal reflux disease (GERD) is a burning pain often felt in the upper belly or lower chest. Remember, heartburn is a symptom, not a disease. It is caused by acid reflux. Acid reflux is the contents of the stomach splashing back up into the food pipe; heartburn is not related to the heart in any way. The confusion comes from the location of the pain, in the chest,” said Prof Nazish Butt, consultant gastroenterologist, head of the Department of JPMC and general secretary of the Pakistan Society of Gastroenterology.

“The stomach produces mucus to protect its lining from the acid that it uses to help with digestion. The food pipe lacks this protection, so acid reflux can damage its lining. Why people with acid reflux experience pain are not fully understood, acid-sensitive nerves may be involved in causing the pain. This burning-type pain usually happens just above the stomach. The acid can also reach higher up, possibly even as far as the back of the mouth,” Prof Nazish Butt explained.

“Common signs and symptoms include a burning sensation in the chest, chest pain, difficulty swallowing, regurgitation of food or sour liquid, and feeling of a lump in the throat, other symptoms include chronic cough, laryngitis or sore throat, asthma or respiratory problems, tooth erosion, bad breath, and disrupted sleep. But some GERD patients do not experience symptoms at all,” she said.

On the other hand, if you are having chest pain that is very brief, lasting only seconds or minutes and going away, without any of these associated symptoms, like the shortness of breath or nausea, it may not be heart-related. The same goes for chest discomfort that gets better with antacids, muscle relaxants, warm compresses, or relaxation and deep breathing. More than one billion people in the world are living with heartburn; it has a prevalence of 17%-42% in general populations. An estimated one in every five adults suffers from GERD in Pakistan.

“Left untreated, acid reflux can lead to ulcers and scarring. Long-term damage changes the cells of the oesophagus lining, which increases the cancer risk, weight loss, gastro-intestinal bleeding, anemia, persistent vomiting, difficulty in swallowing and the onset of GERD after age 60 are symptoms that may warrant an early endoscopy, Prof Nazish Butt said.

“Certain foods and beverages can also trigger reflux. Some common food triggers include fried or fatty foods, citrus, chocolate, coffee, carbonated drinks and alcohol.

Some medications like alpha-blockers, anti-inflammatories (aspirin, ibuprofen, etc.), sedatives and nitrates can also lead to GERD.”

Dr Nazish Butt said a change in lifestyle and diet is an absolute necessity to manage acid reflux. While it is a debilitating condition, with discipline patients can improve their quality of life. A life without acid reflux is possible.

“Regular exercise to avoid obesity, quit smoking and stop the consumption of alcohol, avoid lying down immediately after meals, sit upright or keep the head elevated while lying down, reduce fluid intake before bedtime,” she concluded.

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