Participants: Nick Evenson (Host), Dr. James Marcum
Series Code: UP
Program Code: UP000080B
00:01 Welcome back, you're watching "The Ultimate Prescription"
00:02 and I'm your host, Nick Evenson,
00:04 here with cardiologist, Dr. James Marcum,
00:06 and we're in a series on pain in the body.
00:09 And today, we're talking specifically about chest pain
00:11 which is something that Dr. Marcum
00:13 sees every day at the office.
00:14 And we have some questions that we're going to cover here next,
00:16 and if you have a question, we invite you to go
00:19 to our website at: heartwiseministries.org
00:22 and go to the "Ask-the-doctor" page at the website.
00:25 That's heartwiseministry.org
00:26 and we have a team of medical staff that will look at your
00:30 question and get some personal advice back to you,
00:32 and it's all done in a very private manner
00:35 and secure manner and so go to the website.
00:37 We also ask you to go there and ask for prayer.
00:39 We enjoy joining and reading and praying for people
00:44 who have health concerns and that's what we are all about
00:46 at "Heartwise" is trying to help people connect with our Creator
00:48 who ultimately provides healing.
00:50 You know, Nick, that's what we
00:52 do different than other ministries.
00:53 You know, there are other ministries that talk about
00:56 modern medicine and we do that,
00:58 there's an appropriate place for that.
01:00 Natural remedies - there's a place for that.
01:02 What we like to do is, we like to point people
01:05 to a relationship with the "Ultimate Physician"
01:08 as the true source of healing and if you have that,
01:11 eventually, you're going to have it all.
01:13 And so we like to focus people on that and I love answering
01:16 questions - we don't charge for this. That's right
01:19 It's a service that we do and a lot of people just
01:22 when they have reassurance...
01:23 I can remember one time we sent someone
01:25 to the emergency room and he had a major problem.
01:27 So just getting that knowledge helped him know where to go.
01:32 So a lot of great questions have come into our website.
01:35 Yeah and if you're just joining us - if you didn't see
01:37 the last section, Dr. Marcum's take-home point was
01:40 "If you're experiencing chest pain,
01:42 get help right away because there are 5 things
01:44 that it could be and you don't want to miss those
01:47 if it's a heart attack or an embolism,
01:51 you want to get checked out right away." Absolutely!
01:53 So we've got some questions from the website
01:54 that people have written in and the first one
01:57 is from a viewer who asks, "Is it common for chest pain
02:01 to last for more than a month?"
02:03 That's an interesting question,
02:05 and the way we're going to have to approach that...
02:08 I can't get all the details, but if a person
02:11 has chest pain that won't go away for a month,
02:13 that's usually not the heart because some bad happens.
02:17 It's usually not something dangerous - usually
02:21 because it lasted a month and they're still alive. Right
02:23 But, for that person, it's not common,
02:26 so we talked earlier about it, anytime that pain
02:28 won't go away - we need to find out what's causing it.
02:32 So it could be something as complicated as reflux;
02:37 it might be related to muscles.
02:39 One of the things that also can cause chronic chest pain,
02:41 believe it or not, Nick, is stress. Really?
02:44 Stress - now we want to rule everything else out first.
02:47 We want to make sure it's not the heart,
02:49 it's not the 5 things we talked about. Right
02:51 But sometimes what happens in people that are under
02:53 chronic stress, they make adrenalin
02:55 that makes their muscles tight.
02:57 They also make inflammatory chemicals in the body
03:01 which makes inflammation of the muscles.
03:03 And, of course, when you feel it in your chest,
03:05 you get very, very concerned. Right
03:07 You know if it's a headache,
03:08 sometimes they're not as concerned.
03:10 If it's in the back of the leg, they're not as concerned.
03:12 But if it's in the chest, they need to be concerned.
03:15 So, hopefully, this person that has had chest pain
03:17 for more than a month, has already been
03:19 to see the doctor to make sure it's not
03:21 the first big 5, and then he can go down
03:24 the list of all sorts of different things
03:26 that it could be... from shingles to stress,
03:29 to muscles, to GI tract, to chronic other conditions.
03:35 So, it's not common for it to last that long,
03:37 but still this person needs to seek help and find the
03:40 diagnosis so it doesn't continue...
03:42 Because remember, we talked about what happens
03:45 with long-term stress, Nick?
03:46 Let me see if you remember the last program.
03:48 What happens when you are under long-term pain,
03:50 what does it do to the body?
03:52 It turns on reactions... STRESS, right? Yes
03:55 Chemical reactions and that causes deterioration.
03:59 And it could potentiate any bad system. Okay
04:02 So chronic pain makes whatever is causing it - worse... Right
04:05 including your brain.
04:07 So you're saying that there is a real...
04:10 when we have stress chronically, when we have a job
04:12 that we're stressed out every day,
04:15 that kind of thing causes a real chemical reaction in the body.
04:17 Yes, and it could cause chronic chest pain.
04:19 Now I'm not saying it is for this person,
04:21 but it's a possibility.
04:22 That would have to be looked into after everything else
04:25 was ruled out. Right, right.
04:27 Interesting, so would a vacation help?
04:30 Yes, the opposite of stress is rest. Okay
04:34 And remember that text in Matthew,
04:37 "Come unto Me, all you that labor and I will give you rest."
04:40 So if we come to God in worship, He has promised to give us rest,
04:44 and the three types of rest is spiritual rest,
04:47 the mental rest - how many people get mental rest?
04:50 I read recently that the average person
04:52 spends 12 hours a day in the media. Wow
04:54 Twelve hours! That's a lot...
04:56 That's a lot of stressors. Yes
04:57 Depending upon what they're listening to and then
05:00 we talked about that and then you need the physical rest.
05:03 We were originally designed to rest a day a week,
05:06 to rest at night; people are staying up
05:09 all night; they are awake; they don't get that
05:11 circadian rhythm that turns off the stress chemistry.
05:14 If stress chemistry goes on long enough,
05:16 it could cause pain including chest pains. Right, right
05:19 Let's go on to another question here...
05:21 Someone writes in... "How is a CT scan used to
05:23 evaluate chest pain?"
05:25 A CT scan is a very useful test to evaluate chest pain
05:29 that happens right away.
05:32 It's a CAT scan - people have heard that term,
05:34 but it's very good to look for structural things,
05:37 and also we can look for blood clots.
05:39 On the big 5, we use CAT scans to evaluate for
05:42 pulmonary embolism - this could kill a person.
05:45 We use CAT scans to look at aortic dissections,
05:48 that's when arteries are splitting open. Right
05:50 We use that, but it can also look at other causes
05:53 of chest pain like pneumonia, inflammation in the lungs,
05:57 and other different things that can happen.
05:59 It can also pick up if there's abnormal masses in the lungs
06:03 or in the chest including the things that would cause
06:06 cancer - it can pick up cancer.
06:08 It can also look at the lining of the heart called the
06:11 "pericardium," and sometimes that can get infected
06:14 and also cause us chest pain as well.
06:16 So a CAT scan is a very useful
06:18 structure to look at the insides of the body.
06:22 Now it doesn't look inside the organs,
06:24 but it gives us a picture of the outside of the organs
06:26 which can give us clues as to
06:28 what might be causing the chest pain. Right, right
06:31 Now, I haven't ever had a CAT scan,
06:33 is that the one where you lay on the table and they put
06:35 you inside and you're real claustrophobic in there?
06:37 Yeah, you can be claustrophobic, hopefully you aren't,
06:41 and there is small risk of radiation,
06:44 but hopefully, you're not getting that done
06:47 unless it's something that needs to be done.
06:49 In fact, some of the images... you know that image we have
06:53 behind your head is an image from a CAT scan of the head.
06:57 And so it gives us great images
06:59 of the different parts of the body.
07:01 It can also look at the chest. Right, right.
07:03 All right, how about chest pain
07:06 that comes from the stomach can that happen?
07:08 Well, yes it is, and I wanted to bring this, you know,
07:11 this is a great question because you can have acid in the
07:14 stomach, you can have reflux.
07:16 Sometimes that acid crawls upstream into the esophagus.
07:21 If it comes on right away, sometimes it can feel like
07:24 a heart attack and you can't know the difference.
07:26 So it's always better to be safe than sorry,
07:29 but the typical pain that comes from the stomach
07:32 can come when a person lays down because the valve might
07:35 no close well, so acid comes up into the esophagus.
07:38 It might come after we eat because the stomach might
07:42 get worse after we eat and usually after food.
07:45 It might have a funny taste, funny in our mouth...
07:48 It might taste acidy in our mouth.
07:51 But when the pain comes from the stomach,
07:53 which is a very common cause of pain
07:55 from the acid bubbling up, we want to make
07:57 sure it's not a heart pain. Right
07:58 So if a pain is happening when you do something,
08:01 that really doesn't go with your stomach,
08:03 that goes with your heart. Right
08:04 Pain that comes on after you eat - sometimes that can
08:06 be acid, sometimes it could be your heart.
08:09 In fact, when people come to the emergency room,
08:12 and we rule out the big 5,
08:13 the most common causes that it's not,
08:16 again, once we rule out the significant things,
08:18 it usually ends up being something related to the
08:21 stomach or something related to stress,
08:23 but we can't miss the big ones,
08:25 so you gotta find the big ones first. Okay
08:27 How about shingles? Somebody else write in...
08:30 "Can shingles cause pain in the chest - what are shingles?
08:33 Yeah, shingles is not a fun thing to have.
08:36 That's an infection along a nerve root,
08:39 and everyone has heard about the chickenpox.
08:42 Shingles is sort of like the chickenpox and it gets
08:44 along a nerve root, it can cause extreme pain.
08:48 In fact, I saw a 70-year-old not too long ago
08:51 that just had pain all the time.
08:53 You know, they went to the emergency room,
08:55 and we did the tests, we did the blood work, the EKG.
08:58 We did the CAT scan.
09:00 We couldn't find out what the pain was.
09:01 The pain would not go away.
09:03 So a pain that won't go away is either a
09:05 heart attack or one of these bad things or something else.
09:08 So we said, "Wow, we don't really know what it is."
09:11 We don't know and the pain is just excruciating.
09:13 Well, in a day or two, guess what happened?
09:16 They had a characteristic rash, a shingles rash
09:19 that came right where that nerve was going around their chest,
09:23 and we knew that their pain was from the shingles infection,
09:27 and nowadays, if people are exposed to shingles a lot,
09:32 there are even vaccines they can give.
09:34 Some people that have a weakened immune system
09:37 might consider that because stress triggers shingles
09:41 because our immune system can't keep that infection down,
09:45 and it becomes activated, it is very painful and it can
09:48 occur in other places.
09:49 It can occur in the face; it can occur on the body;
09:52 and it can occur in any dermatome where a nerve lives,
09:55 and it is very painful.
09:57 So shingles is a cause of pain.
10:00 It's usually not chronic pain, it's acute pain,
10:03 pain that won't go away, and there are some things
10:05 that we can do to help treat that pain
10:07 until the virus runs its course.
10:09 So the pain from shingles, it could be in the chest
10:11 or it probably could be in other parts of the body as well?
10:13 Yeah, we found out on this one because it was in the chest,
10:15 we evaluated it, we didn't know for sure
10:17 until guess what? The virus came,
10:20 and then we saw the rash along the nerve root,
10:23 and we knew they had shingles.
10:25 So you mentioned earlier that pain is often associated
10:27 with heart attack, but is it possible to have
10:29 heart attack without experiencing pain?
10:31 Yeah, it is, and especially in women.
10:35 Women don't present quite the same as men.
10:39 They have a different pain mechanism in their bodies.
10:42 Their blood vessels in the heart are a little
10:44 bit different - they're smaller.
10:46 Because of their hormonal system,
10:47 they experience things a little bit different.
10:49 Sometimes women will just have shortness of breath,
10:51 extreme shortness of breath instead of chest pain.
10:54 Sometimes if a person has diabetes
10:57 or damage to their nerves...
10:58 Remember we talked in previous programs when the nerves are
11:01 damaged, some people don't feel pain at all.
11:05 We see that occasionally in diabetics,
11:07 and people that are old.
11:09 They might just present with extreme fatigue,
11:11 shortness of breath, a lack of energy,
11:14 and we say, "Wow, what could that be?"
11:16 And we do some testing and wow, it ended up being the heart.
11:19 Now that's not as common, we don't see that as common,
11:22 but it is possible to have a heart attack without pain.
11:25 So when someone comes in with symptoms that we have
11:27 no explanation for, since heart disease is so
11:30 common in our world...
11:31 In fact, heart disease was one of the highest killers
11:35 in the United States last year and as we get westernized,
11:38 and have more stress, more fatty foods, guess what?
11:42 We are going to have more problems with
11:44 cardiovascular disease. Yeah
11:46 We've got just another question here, somebody writes in...
11:48 "Why is chest pain evaluated so quickly in the emergency room?"
11:53 I think I've got a little bit of an idea because you
11:55 mentioned the big 5 earlier: heart attack,
11:57 pulmonary embolism, pneumothorax,
12:01 and a dissection, and what was the other one?
12:03 Unstable angina, that's where it's sort of getting
12:06 to a heart attack, but it's not quite there.
12:08 Well, a person that's having pain right away...
12:10 if they're having a heart attack,
12:13 you have to get treatment right away because when
12:15 the heart doesn't get enough blood,
12:17 it becomes electrically unstable. Right
12:20 It doesn't get enough blood and the heart, you know,
12:23 if it doesn't get enough blood, electricity has problems,
12:26 and it starts to fibrillate, and I don't know if you've
12:29 seen TV where they get the defibrillators out
12:31 and shock the heart. Yeah
12:33 Even a small blockage can cause that to happen.
12:36 The heart gets electrically unstable,
12:38 it goes into funny rhythm.
12:39 They have ventricular tachycardia,
12:41 ventricular fibrillation and sudden, sudden death.
12:45 So that's just one of the reasons it got to be
12:47 jumped on quickly and I can't tell you how many people
12:49 that we've had to shock in the emergency room
12:51 that were having a heart attack. Right
12:53 So it's a big problem, they've got to go quickly,
12:55 and if you're in an emergency room and you're having
12:57 chest pain, if someone has not evaluated you,
12:59 you better make some noise!
13:01 Because we want you to be evaluated as quickly
13:03 as possible to make sure it's not something super serious
13:05 that needs immediate help.
13:07 Well Dr. Marcum, thank you for teaching me and the rest
13:09 of our audience about chest pain and why it's
13:11 important to get evaluated so quickly.
13:13 Well, hopefully, we'll never have chest pain,
13:15 and we can do things, little things to do to stay healthy.
13:18 We talked a few about keeping the stress down,
13:21 healthy diets, keep the fat down.
13:23 And then if you're having symptoms, get help right away.
13:27 Well, you know, we believe that God is going to provide
13:29 ultimate healing one day and we invite you to visit our
13:32 website at: heartwiseministries.org
13:35 where you can ask for prayer and you can also ask
13:37 more health questions there.
13:38 Stay with us as Dr. Marcum will
13:40 be closing the program with prayer.
13:50 I hope everyone has learned a little bit about
13:53 chest pain today and the real take-home point
13:57 I want you to have is: If you're having
13:58 chest pain that won't go away, or an abnormal feeling
14:01 above your waist or diaphragm, seek help right away.
14:05 Get medical help because we don't want it to be
14:07 something that could actually kill you,
14:09 so get help right away.
14:11 Let me pray for you today...
14:12 Father God, We want to pray for all of our
14:15 audience today that You continue to be the Ultimate Physician
14:18 for them and if they ever have chest pain, Father,
14:21 we pray that you be with them and help them to get help
14:23 right away is our prayer... Amen
14:26 If you might have questions, we want to invite you
14:29 to go to our website, that's: heartwiseministries.org
14:32 I'd be happy to answer your questions,
14:34 and we're going to continue our series on pain,
14:37 so stick with us each time and we will go into another aspect
14:41 of pain next time.