Cardiac Gambling

by Frederick Jaccarino, M.D.

A recent cocktail party conversation turned to the subject of chest pain. After stating that everyone gets chest pain, most people nodded agreement, while one woman firmly disagreed, saying she’s never had chest pain. Probably true, but my intended point was that there are many different cause of pain in the chest which are not heart related, and often not even worthy of worry. Indeed, most people will have to deal with chest pain at times. Heart attacks however, usually leave survivors a memory of a pain which heralded that attack’s presence.
The heart beats sixty to one hundred times a minute in the middle of the chest. Our very survival depends on the circulation of blood powered by the powerful heart muscles which contract with each beat. Each contraction squeezes out a volume of blood to the body, then relaxes to receive a new volume ready for the next beat. Also in the chest are the lungs, which expand and contract to bring oxygen and other gasses into and out of the body. Likewise, food and fluids get into the body by passing through a hollow tube, the esophagus, which is in the chest. The esophagus does some squeezing itself, to keep things moving in the right (or sometimes wrong!) direction. All these activities occur efficiently and continuously without any conscious effort or awareness. Any malfunction of these vital functions will be urgently brought to our conscious awareness by some uncomfortable sensation such as pain, nausea, or suffocation sensations. That these feelings are hard to ignore is a good thing for survival. Other structures that may cause pains in the chest are ribs, muscles, the gallbladder, liver and pancreas, to name a few.
So, back to the original premise; there are many possible causes of chest pain, making it a common phenomenon. The patient, and often a doctor, must try to differentiate the characteristics of the pain in order to assess the risk it poses, and the best path to relief. That is a taller order than it appears on first glance. Even highly competent physicians, with the assist of testing and technology, will miss some heart attacks, while over-testing patients with pains unlikely to be due to a diseased heart. Your best bet is to know your own risk factors, pay attention to the circumstances and characteristics of your discomfort, and let common ( too often uncommon ) sense dictate your own plan of action.
A brief word on risk factors. Smoking, obesity, cholesterol, stress, and hypertension are all manageable; choosing to not manage them is merely the choice of higher risk. Age and genetics are inevitable, but nevertheless important to risk assessment. Life makes us all gamblers; when it comes to health both the patient and the doctors gamble. A wise patient will win and walk away more often than the reckless, but may still be felled by lady luck. A prudent doctor tries to improve the odds of his bets by evaluating every available clue so that he may help the patient’s quest to avoid their bad bets.