Chest pain, blocked arteries, angina and heart attacks are different aspects of one large topic
Blocked heart arteries are the largest concern in Western medicine because they are responsible for over half the deaths in any one year. Any warning that permits intervening with these arteries before they hurt their owner is precious.
The most common early warning that individuals receive warning of blocked arteries and impending heart attacks is the experience of chest pain. For this reason all doctors take the complaint of a new or increasing chest pain very seriously.
Now heart disease is not the only condition that causes chest pain. The physician's chore is to listen carefully to the description of the chest pain and the circumstances in which it arose. Once the nature of the chest pain is recorded and the patient is examined a decision has to be made as to the cause of the chest pain. Sometimes the cause will be obvious. There was trauma or an obvious infection and the patient can be quickly diagnosed and treated. In other cases the cause is obviously the heart and treatment can be initiated promptly.
More often there is no great certainty as to the cause of the pain and tests have to be ordered to investigate the cause of the chest pain. Frequently the investigation will start with an electrocardiogram, a blood test to look for anemia, diabetes and kidney fucntion and possibly a chest Xray. In most healthy people these are normal. Then attention turns to more direct testing of the heart's arteries.
Traditionally this involves a stress test. There are many different types of stress test and the patient has to be matched with the most appropriate test for his/her circumstances. The many different types of stress test exist because each one has limited accuracy and there has been a long series of attempts to improve the accuracy of the stress test by introducing new tests.
A completely different type of test entered the arena in the last ten years. The biomedical engineers coupled a CT scanner with very powerful computer techniques. With this they are able to get pictures of the heart's small constantly moving arteries that are very similar to angiograms in a twenty minute procedure on a CT scanner which is a test that is familiar to most people.
The ultimate test of coronary arteries is the traditional angiogram, where very thin plastic tudes are introduced through the leg or the arm arteries and pushed to the heart's arteries. After the injection of dye a series of pictures is taken looking for blocked areas of the heart's arteries. With modern techniques this is quite safe and painless. However it requires a day in a cardiology lab, some inconvenience and a very small risk. This is why the other tests are used first to try and select out the individuals who do not require such detailed testing.
If all this testing reveals blocked arteries the exercise involves repairing them when needed and starting medical therapy. If there are no blocked arteries and the most dangerous possibility of hear disease is excluded it is back to the drawing board to look for other causes of the chest pain.
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