The other day a patient, a young man in his late twenties came to my clinic with severe chest pain. He had laboured breathing. Four to 5 people escorting him also marched into my chamber unasked and of course unmasked. The boy was clasping his chest with both hands and when he was made to lie down he attained embryonic position. O/ E (on examination) his vitals were WNL (within normal limits). No family history of heart disease, no past history, no addiction to alcohol and smoking. Upon detailed history, he confessed that he attended Gym after a gap of 2 yrs and started vigorous weight training exercises on very first day.
It was severe muscle strain due to unaccustomed activity, which got eased within 2 hrs with anti-inflammatory and muscle relaxants.
Perhaps chest pain is amongst the most common complaints in either GP or cardiac practice. When a patient comes with chest pain, a doctor cannot ignore him/her taking it as trivial matter. However, busy doctor may be, he/she has to be more alert when such patient steps in. Because this particular ailment is confusing and can land a doctor in trouble. So a physician has to think twice before he/she comes to a proper diagnosis. There are instances where doctors have just scoffed at patients’ complaints saying ‘oh it’s just a muscle pain” and few moments later patients have collapsed and died before they reached home.
Therefore patient history is most important in this case. Causes of chest pain are numerous and may be classified roughly in 5 broad categories. 1) Heart related issues including acute MI, CAD (coronary artery disease), hypertension etc, 2) lung diseases like bronchitis, pneumonia ,pleuritis, etc, 3)stress related, 4) muscle spasm( intercostal)and costochondritis and 5) Gastritis (gas, acidity).
From time to time we also hear about physically fit persons or even athletes suddenly complaining severe chest pain and collapsing in Gym or during marathon or on the playfield from cardiac arrest. Here most of the time there is underlying cause like arrythmias, pericarditis, cardiomyopathy or even hyperlipidemia.
Sometimes atherosclerotic plaque ruptures during vigorous activity and blocks coronaries.
Retrosternal pain, chest pain radiating towards neck, left arm, associated with sometimes profuse sweating, nausea, could be strong indicator of angina or MI (myocardial infarction) and should be given due attention and cardiac status must be assessed quickly by ECG, ECHO, and TMT (treadmill test) or stress test.
But of late, a typical form of chest pain has baffled public in general and doctors community in particular. This usually is seen among MLAs, ministers, pampered babus, gangsters, scamsters, land sharks, et al after central agencies such as ED, CBI, IT, .raid their premises and arrest them.
Most of the times it is all of a sudden and the cause is not found even in the textbooks of internal medicine. These so called VIPs are admitted minutes after their arrests with ‘chest pain’ in 5 star hospitals with all luxury around.
