HJAR Jan/Feb 2023

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2023 55 Oyidie Igbokidi, MD Interventional Cardiologist CHI St. Vincent Heart Institute It can present itself in different forms for different people, including a sharp pain or burning discomfort. If a patient says their chest pain is brought on by exertion and re- lieved by rest with the associated symptoms like shortness of breath or sweating, then I would say this sounds like classic angina. If the symptoms are mild, patients should call their primary care physician andmake an appointment. Some chest pain that is atypical and noncardiac could be something simple like acid reflux or other muscular or skel- etal causes, but it is important that we know and especially so if they are at higher risk for heart disease. If the pain is severe and sudden with symptoms such as shortness of breath, profuse sweating, nausea, vomiting, or ab- dominal pain, emergency medical services should be called immediately. The patient’s understanding of their own body will often help in determining the necessary cause of action for angina. TREATING ANGINA Treatment for angina varies depending on the patient and the symptoms presented. If we know that a patient has angina, their symptoms are not escalating, and their pain is easily relieved by either rest or medication, we call it stable angina. Those that get treated in an emergency room setting will require different medications from those treated in an outpatient clinic. THERE are so many different underlying health issues that cause chest pain that the key is recognizing the difference between common aches and pains and when the se- verity or nature of that pain requires a visit with a healthcare professional. Much of that decision also comes down to the individual patient and their underlying risk factors for cardiovascular disease. As an interventional cardiologist in Hot Springs, I see a lot of patients with chest pain or cardiac etiology. We have to be sure that we’re looking at that patient based on the risk factors that increase the probability that the pain is coming from the heart. Those risk factors are frequently other conditions such as diabetes, hypertension, high cholesterol, smoking, or a family history of early-onset heart disease. UNDERSTANDING ANGINA One of the most common types of chest pain we see is angina, which is caused by re- duced blood flow to the heart. Symptoms of angina often present differently for men and women. Men suffering from angina will typi- cally feel tightness, pressure, or discomfort in their chest, particularly during moments of stress or strenuous activity, which may spread to the jaw, shoulders, arm, or neck. Women, on the other hand, will often have symptoms unrelated to the chest, includ- ing nausea, vomiting, a sudden breakout in sweat, or abdominal pains. Some patients suffering from angina may require nitroglycerin for their symptoms. Ni- troglycerin provides relief to angina patients by relaxing and widening blood vessels, al- lowing blood to flowmore easily to the heart. However, there are steps that should be tak- en before ultimately taking a nitroglycerin capsule. For patients who have experienced angina in the past or are familiar with the classic angina symptoms, we ask them to first stop what they’re doing and sit down. If symp- toms do not resolve within five minutes, we would advise them to take nitroglycerin. If they don’t feel any better after another five minutes, they can use a second nitroglycerin capsule. I typically tell my patients that if they are still experiencing symptoms after two nitro- glycerin capsules, they should call 911. We advise them not to get into the car or have someone else drive them to the emergency room, especially if the symptoms are escalat- ing despite taking the nitroglycerin. The general rule should be that if a patient experiences chest pain or any discomfort that is new, persistent, and greater thanmild, they should seek emergency care. n Oyidie Igbokidi, MD, is an interventional cardiolo- gist with the CHI St. Vincent Heart Institute based in Hot Springs and serves patients across the Southwest region of the state.