Case: Chest Pain

Male: Age 67

D: Hello, I am Dr. Khan. How can I help you?

P: I’ve got pain in my chest.

D: How would you describe the pain?

P: It is a heavy, crushing sort of pain.

D: Does the pain go anywhere else?

P: Yes, it seems to go up to my jaw and down my left arm.

D: When did the pain start?

P: About half an hour ago.

D: What were you doing when the pain started?

P: I was watching the boxing on television.

D: Did the pain start suddenly?

P: No, it came on over a minute or two.

D: Does breathing in make the pain worse?

P: No.

D: Have you ever had a pain like this before?

P: I suffer from angina but this time the pain is much worse and it didn’t go away when I put the little tablet under my tongue.

D: Have you been sick?

P: No, but I feel sick.

D: Have you felt your heart fluttering or thumping in your chest?

P: No.

D: Do you feel short of breath?

P: Yes, I have felt breathless since the pain started.

D: Do you ever get heartburn when you lie down or bend over?

P: No.

D: Have you suffered from any flu-like symptoms such as a headache or a sore throat?

P: No.

D: O.K. just relax. I am going to examine you now.

Ex. 19. Find in the texts the answers to the following questions:

а) What is the cause of ischemic heart disease?

2. What is the most common symptom of a heart attack?

3. What are the types of angina pectoris?

4. What is the difference between these two types?

5. What is myocardial infarction?

6. What are the classic symptoms of it?

What are the most common kinds of heart disease?

We all have good reasons to protect our hearts. Cardiovascular disease today is the leading cause of death and disability in the industrialized world. In America alone heart attacks claim 540,000 victims a year. And another 155,000 die annually because of damage of blockage in arteries supplying blood to the brain, resulting in stroke.

There are many different types of heart disease, many reasons why they strike. The most common kind of heart disease is caused by an insufficient supply of oxygen to the heart – known as ischemic heart disease. Here are some of its more common forms.

Heart Attack.

A heart attack occurs when the heart receives an inadequate supply of oxygen-carrying blood. During a heart attack, this lack of oxygen causes serious damage to part of the heart. The most common symptom of a heart attack is chest pain.

Angina.

The term “angina” refers to chest pain usually caused when the heart’s deprivation of oxygen is moderate, rather than catastrophic. There are two types of angina:

“Stable angina” is chest pain that is predictable. That is, it almost always occurs during physical exertion or emotional distress. The heart is saying “I’ve got to have more oxygen, or you have to stop making me do so much work”.

“Unstable angina” is chest pain that is not predictable. It can occur even when one is resting or it can occur during exertion, and keep on hurting even afterward. It may also indicate that previously stable angina has suddenly worsened. Unstable angina often precedes serious heart attack.

Myocardial infarction.

Coronary insufficiency may result in myocardial infarction that occurs either with or without occlusion of a branch of a coronary artery. The classic symptoms are: 1) pain, 2) shock, and 3) dyspnea. The pain is similar to that of angina in location. It is not caused by exercise, not is it relieved by rest.

Ex. 20. Read the text. State the main idea of it. Compare the character of pain in angina pectoris and in myocardial infarction. Fill in the table:

	angina pectoris	infarction
cause of pain
location
duration
intensity
others