Dr. Sanjay Mehrotra

Blockage in heart is a common term used for narrowing of coronary arteries. Coronary arteries are vessels, which supply blood and thus oxygen and food) to continuously working heart muscles. Heart muscles which are not tired working from the birth till death, however, cannot sustain long without blood supply.

A reduction in blood supply gives rise to ischemia of heart muscles commonly manifested as chest discomfort or angina. A sudden complete shutdown of blood supply leads to heart attack leading to permanent damage to heart (if blood flow not reestablished promptly).

But what causes these arteries to block? Deposition of LDL cholesterol (low density cholesterol) in inner surface of coronary arteries is the primary reason of these blockages. LDL a normal component of blood (upto certain limit) starts depositing in arteries as early as 10 years of age!

Deposition of billions of LDL molecules over several years on inner surface of arteries gives rise to visible narrowings in these arteries. Flow ahead of these narrowings is reduced in proportion to the narrowing. At a level of 70 % narrowing the flow is reduced to give ischemia (and angina) during exercise. Gradually increasing degree of narrowing reduces the exercise needed for ischemia and angina; a narrowing of more than 90 % can give symptoms at rest. A sudden clot formation at any of these stages can block the flow suddenly giving a heart attack.

If LDL is a normal component of blood, why it is deposited in the arteries at first place?

LDL above a certain limit in blood starts depositing in the arteries. Diabetes, Hypertension, smoking, less exercise and genetics makes it more sticky thus making narrowing faster. This is why these risk elements need to be properly attended for prevention from heart disease. For treatment medicines are important for stopping the progression of narrowings; angioplasty is a method of fast resolution of blockage; and bypass surgery is the method of creating a whole new blood supply for the affected part of the heart.

In case you have a concern or query you can always consult an expert & get answers to your questions!

If you thought that chest pain occurred only due to a heart-related issue like a heart attack, you are wrong. Chest pain is one of the most common reasons that people visit the emergency services and it can be caused due to problems with your heart, lungs and digestive system. 

Chest pain can be due to either of these two main reasons:

Heart- related Issues

1. Heart attacks called myocardial infarctions are very common reasons for chest pains. During a heart attack, the blood supply that serves the heart with oxygen is cut off due to plaque build-up in heart arteries causing the death of heart muscles. 

• Other reasons for heart attacks are blood clots or torn blood vessels. 
• Not all people having a heart attack have symptoms. Usually, people report symptoms like chest pain, upper body pain, nausea, sweating, fatigue, and trouble breathing.
• A heart attack is a serious medical emergency for which immediate care is needed.

2. Angina pectoris is a type of chest pain that results from reduced blood flow to the heart. Low blood flow means your heart doesn’t get enough oxygen. The angina pain is often triggered by physical activity or emotional stress and feels like a vice squeezing your chest or a heavy weight on your chest. It can also spread from your chest to your neck, arms, and shoulders. Other symptoms are fatigue, dizziness and nausea and these normally last up to 15 minutes only.

3. Unstable angina which causes crushing chest pains suddenly and even when you are not doing anything strenuous is a medical emergency as it can lead to a heart attack. This usually shows that your heart, arteries are narrowing alarmingly.

4. Other heat-related reasons for chest pains are-

• Mitral valve narrowing or stenosis
• Heart arrhythmias
• Coronary Artery disease
• Inflammation of heart muscles or pericardium and weakening of the heart muscles. 

All of these are emergencies and need immediate medical attention to prevent a fatality.

Not Heart- related:

1. Lung conditions like Pneumonia, Bronchitis, Pulmonary embolism. 

• Pneumonia is an infection in one or both lungs caused by fungi, bacteria, or viruses. It causes inflammation in your lung’s air sacs and makes them full of pus which makes it difficult to breathe and causes chest pains, amongst other debilitating symptoms.
• Bronchitis is an inflammation of your bronchial tubes. It can be chronic or acute and it can cause a cough with mucus and chest pains. 
• Pulmonary embolism is a blood clot that occurs in the lungs. It can go on to damage parts of your lung due to limited blood flow. Apart from this, it can also decrease oxygen levels in the blood and affect other organs. 

It can be life-threatening due to permanent lung damage. The most common symptom of a pulmonary embolism is gradual or sudden shortness of breath. 

There is also- 

• bluish skin tone 
• anxiety
• fainting
• hest pain that extends into your arm, jaw, neck, and shoulder
• lightheadedness

2. Rib cage inflammation or Costochondritis is also known as Tietze’s syndrome. It is an inflammation of the cartilage in the rib cage. Patients experience chest pain in the upper and middle rib area on either side of the body due to this. The pain can also radiate to the back or the abdomen, getting worse if you move, stretch, or breathe deeply.

3. Food pipe disease or Esophagitis is any inflammation or irritation of the oesophagus, a tube that sends food from your throat down to your stomach.

Common causes of food pipe disease are acid reflux or GERD and bacterial or viral infections. 

GERD- This condition occurs when the stomach contents and acids back up into the oesophagus. This causes chest pain that can mimic a heart disease. There may also be oesophagal spasms due to GERD.