(October 24th, 2007 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a particular medical condition.

This week, we have Dr. Paul Malik, MD, FRCPC, a Cardiologist at Kingston General Hospital and an Assistant Professor in the Department of Medicine at Queen's University.  Dr. Malik explained what he would do if he was experiencing a sudden onset of chest pain.

I'd like to thank Dr. Malik for lending his insight to Insidermedicine's If I Had.

Dr. Malik: So, if I had chest pain and I were a patient, the first thing that would be important to say about that is that I wouldn’t worry, I wouldn’t get so upset about the chest pain. It’s not very useful to worry about these things. Chest pain has a lot of different causes. Everything from very minor nuisance things like muscle pulls to very serious things like heart attacks and such, so there’s no point in worrying about it until you know for sure what the cause of the chest pain is. The second important thing about chest pain is that don’t self-diagnose. Chest pain can be a lot of different things, as I say, and there’s a danger to self-diagnosis and that is to get to the wrong diagnosis, and so the big part of cardiology is achieving adequate treatment quickly. So if you are self-diagnosing, then perhaps you are delaying the initiation of treatment.

If I had chest pain I think it’s important to be evaluated by a medical professional, as I say. It’s important not to drive yourself to the hospital either, to take an ambulance. When you’re in the emergency room, they’ll do a variety of things that will sort of help in terms of elaborating the cause of the chest pain. They’ll take the patient to a monitored bed. They’ll do an ECG, they’ll do some blood work. Blood work is designed to take a look and see if there’s been any heart muscle damage, looking at kidney function, looking at blood coagulation studies. We’ll do a chest x-ray to see if there are any other causes of chest pain besides the heart and the lungs, for example. If the electrocardiogram is abnormal, and by abnormal I mean that there are some certain portions of it which will show changes, such as the ST segment. We talk about the ST segment in terms of abnormalities and blood flow to the heart, then physicians are worried about heart attacks and so then they will initiate treatment promptly.

The most concerning type of heart attack is a so-called ST elevation myocardial infarction. Myocardial infarction stands for heart attack, and that kind of problem is treated emergently with a treatment to try and open up the blocked artery very quickly. So if a diagnosis of ST elevation myocardial infarction is made, the doctor will initiate one of two things: the first is either a medication to try to break up a blood clot that has happened within the artery, that is occluding blood supply in that artery. Or, to make a referral for an emergency angioplasty and that’s where we actually go in and take a look at the arteries directly, find out which artery is blocked, and the try to open it up with a balloon and a stent. So that’s emergency angioplasty, and those are two ways to open up the artery quickly, but the primary benefit achieved from a heart attack is going to be if the artery is opened up quickly, so that’s why it’s important not to delay treatment at home, but to really seek medical attention sooner rather than later.