Chest pain arising from the heart is called angina. Usually it is due to narrowings in the arteries that supply the heart muscle – the coronaries. When things are stable in the coronaries angina typically occurs on exertion and is relieved by rest. Any discomfort brought on in this way should be assessed to see if it is due to heart disease.
If something changes in the blood vessels angina can occur at rest, even leading to a heart attack. Chest pain at rest or on minimal exertion is one of the commonest reasons for admission to hospital and makes up a large proportion of my work as cardiologist.
Although coronary disease is the most common cause of angina it can also be caused by valve disease and by diseases of the heart muscle itself. We have four valves in the heart that open and close each heart beat to keep the blood circulating the right way. If a valve doesn’t open properly the heart has to work harder to keep the blood moving forward and this can lead to angina.
Chest pain has many other causes, some benign like pain from the muscles of the chest wall, some less so like clots to the lungs called pulmonary emboli. If cardiac chest pain has been excluded it may be necessary to investigate for other causes, though usually we first need to be sure that it’s not the heart.