Participants: Nick Evenson (Host), Dr. James Marcum
Series Code: UP
Program Code: UP000080A
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00:16 Have you ever felt a sharp pain in your chest,
00:19 or maybe a dull burning, aching or tight squeezing sensation? 00:23 Well on today's program, we'll be discovering 00:25 the root of the problem, so stay tuned... 00:28 I'm Dr. James Marcum, are you interested in 00:31 discovering the reason why? 00:33 Do you want solutions to your healthcare problem? 00:36 Are you tired of taking medications? 00:39 Well, you're about to be given "The Ultimate Prescription" 00:45 The first thing that most people associate with chest pain 00:49 is a heart attack, but there are many more 00:51 things that can cause it... your lungs, 00:53 esophagus, muscles or even your ribs. 00:57 So how do you know when it's chest pain 00:59 that you need to be worried about - if it's a heart attack? 01:01 Well, Dr. Marcum is here and welcome to the program, 01:04 and Dr. Marcum, tell us a little bit about chest pain. 01:06 It's something you see every day, correct? 01:08 Yeah, chest pain, Nick, is something I see every day. 01:11 It's how I make my living is seeing patients with chest pain. 01:14 And, you know, we've been talking about different pains 01:18 in different parts of the body in our series on pain... 01:20 And today, we're going to focus on pain above the diaphragm 01:24 with chest pain, basically above the diaphragm, 01:26 and below the neck. 01:28 And, the reason I think this is so important is because we 01:31 talked about different types of pain and any pain 01:35 above the diaphragm could be potentially life-threatening, 01:39 and we want to help our listeners and viewers know 01:43 when they should be very concerned, 01:45 when maybe they shouldn't be so concerned, 01:47 and what they should do when they 01:48 have pains above the diaphragm. 01:50 So I think this is a very interesting subject, 01:52 something I do every day. 01:54 Yeah, and in this series, we're going to cover 01:55 a bunch of different kinds of pain. 01:57 Today, we're covering chest pain, 01:58 but we're going to talk about pain from different areas, 02:01 the back, the head, different areas... 02:04 But today we're talking specifically about chest pain, 02:06 and how do you know, as a patient, how do I know 02:11 when I need to come see you for all the chest pain. 02:14 That's what we're going to talk about 02:16 during the course of the program. 02:17 It's a very complex subject and it's something that 02:21 we have a clip that we're going to show about 02:24 some of the general approaches and some of the tools 02:26 we have to evaluate this once people do come, 02:29 and then after that clip, I will get an answer 02:32 to that question that you just gave me. 02:33 It's going to take a long time, 02:35 probably the rest of the program to answer. 02:36 All right, well we recently took our cameras to Dr. Marcum's 02:39 office to see some of the tools that he uses in helping 02:42 to diagnose chest pain, let's have a look! 02:44 Chest pain can be caused by many things. 02:48 Of course the most concerning is the heart, 02:50 but in this area we have the heart, we have muscles, 02:53 we have the lungs, we have nerves, 02:55 we also have the esophagus and stomach contents 02:58 that sometimes has caused chest pain as well. 03:01 So the first thing I do is do what we call a history 03:05 and the physical. 03:06 That's where I sit down with the patient and basically 03:09 ask them a lot of questions regarding the chest pain. 03:12 When did it start? How long did it last? 03:15 Where does it radiate? What makes it worse? 03:19 What makes it better? 03:20 Then I examine the patient and this would include 03:23 taking a blood pressure, feeling their heartbeat, 03:25 listening to their heart, pressing on parts, 03:29 and getting information. 03:30 So the history guides me to what physical exam I need to do 03:34 to confirm my diagnosis or not. 03:36 Then the next thing is we have a bunch of diagnostic tools. 03:40 Almost everyone that comes in to the office get an 03:43 electrocardiogram, an EKG. 03:45 This tells me about the rhythm of the heart. 03:48 The characteristics of this might tell me if there 03:51 has been an old heart attack; if there's a dangerous rhythm; 03:54 the size of the chambers. 03:56 Usually, we also get an x-ray. 03:58 A chest x-ray is very valuable. 04:00 It lets me know if the heart has been damaged, 04:02 if the heart is enlarged. 04:03 It also lets me look at the lungs in case 04:05 the lungs might be causing the pain. 04:07 If I still need more information, 04:09 then another test I might do is a treadmill test 04:12 where we walk them on the treadmill. 04:14 If the pain comes back on exertion, 04:17 that's very characteristic of what we call "angina" 04:20 where the heart is not getting enough blood. 04:23 Not only do we have the treadmill where we can look at the EKG 04:26 and ask the patient if he hurts when he does things, 04:28 we also have some fancy imaging. 04:30 We have the echocardiogram where we look at the muscle 04:33 to see how it performs when they exercise. 04:36 We also have a nuclear scan where we put in isotope 04:39 that goes throughout the heart, 04:41 and we can look at characteristic patterns. 04:43 Of course if we think it's due to the arteries of the heart, 04:45 we have a more advanced test called a heart catheterization 04:49 where we put dye inside the heart to see if a person 04:52 might benefit from having a stent or a bypass surgery. 04:56 So, in general, when it's due to the heart, 04:59 there are a couple of characteristic 05:00 pains I want you to know about... 05:02 If a pain that's above your waist or a discomfort 05:05 that will not go away, that could be a heart attack. 05:08 So you need to get to the emergency room right away 05:11 to get an EKG, maybe to do some biomarkers, 05:14 that's blood work to see if your heart is damaged. 05:16 If a pain happens when you do something and goes away 05:19 when you rest, that's also characteristic of the heart 05:23 because the heart hurts when it does something, 05:25 and it goes away when you rest. 05:28 If it hurts when you take a deep breath or breathe, 05:30 that could be related to lungs or muscles. 05:33 If it hurts when you lay down at night, 05:35 that could be related to acid. 05:37 And then there's all sorts of pains in between. 05:40 So this is just a brief overview of causes of chest pain 05:44 and some of the diagnostic tools I use to evaluate the heart. 05:49 You know, Dr. Marcum, that was very interesting 05:50 to see some of the tools that you use every day, 05:53 and, you know, I haven't experienced chest pain myself, 05:56 so it was really neat to see some of the tools. 05:58 Almost everyone sooner or later usually has pain 06:01 above the waist, above the diaphragm and the reason 06:05 it's so serious is if you're having a heart attack 06:08 and it's undetected - that's potentially life-threatening. 06:12 So the place to go, if you have pain that you don't 06:14 know where it is, is to go to the hospital; 06:16 get evaluated quickly because now we have the technology 06:20 that if you are having a heart attack, we can go 06:23 up inside the heart... 06:24 We can open up that blood vessel usually with a stent, 06:28 then you can receive more blood and then we can 06:30 abort you losing that heart muscle and abort the 06:34 dangerous things that happen, the dangerous rhythms... 06:36 And every year, you hear someone 06:38 that dies suddenly from a heart attack. 06:40 And a lot of people don't realize it, 06:42 but half of all people don't find out that they have 06:46 heart disease until they have the heart attack. Right 06:49 It's very much a hidden disease, Nick. 06:51 It's a disease that we accumulate over time, 06:55 and we get heart disease because of our diets. 06:58 You know, we eat these high fat diets. 07:00 If you eat more than 15 to 20% of your calories in fat, 07:03 it's stored. Right 07:04 It's stored in the arteries, not only the heart arteries, 07:07 but arteries all over the body. 07:09 It could be stored as fat and if it's accumulated over time, 07:13 sooner or later it can cause a problem. 07:15 And, of course, the largest problem in the heart 07:17 is a heart attack. 07:19 So a lot of people say, "Oh, I've never had pain before, 07:21 this is not a heart attack, it's my stomach or something else." 07:24 But sometimes you cannot tell the difference between 07:27 reflux pain and heart attack pain. 07:30 Now frequently, when you're having a heart attack, 07:32 there are multiple symptoms. 07:34 You know, there is also having pain that's feels like something 07:38 is crushing you; you might not be able to 07:40 breathe well; you might have palpitations. 07:43 Usually there's something else that goes with it, 07:45 but any pain that you're not sure of, 07:46 I think you'll really have to get to the hospital right away. 07:49 Now the people that come to my office, 07:51 are the people that have stable pain. Okay 07:54 They're not having pain every single second. Right 07:56 So the first point today that we want to leave all of our 07:59 viewers with - if you are having pain, 08:00 you don't know where it's coming from, 08:02 you need to get to the emergency room right away. 08:05 It could save your life. Yeah 08:07 So there's heart disease and there's heart attacks, 08:11 what are some other acute causes of chest pain? 08:15 Well, when I have an intern or someone working with me, 08:18 I sort of give them the 5 big causes of chest pain 08:22 that they have to evaluate for right away. Okay 08:25 So let's say you're having chest pain and it won't go away... 08:29 Okay, well one of the things that we have to know 08:31 right now - before we can even let you out of 08:33 the emergency room - the first one is a heart attack. 08:37 We do that with EKGs and we use some blood work with that. 08:43 If you are having a heart attack, 08:45 we take you to the angiography suite, 08:47 we try to open up that artery right now - can't wait. 08:51 If you miss a heart attack, this person could have 08:54 sudden death - so it's very, very important. 08:57 Another cause is a pulmonary embolism, 09:00 and a pulmonary embolism is a clot that comes 09:04 usually from the legs or lower extremities and it goes 09:07 into the lungs and it can cause a major issue, 09:12 and you can have sudden death from a pulmonary embolism. 09:15 We've heard some stories, through the years, 09:17 of people that sit for a prolonged period of time, 09:19 they don't move their legs. 09:21 They get clots in their legs, the clot breaks off, 09:24 goes to the lungs and kills them. 09:26 Sometimes we see that in a hospitalized patient, 09:28 the patient that doesn't move around very much. 09:31 That's why I tell everyone, every hour, you need to move 09:33 around - move those legs. 09:35 It helps the bowels move, it helps to break up. 09:38 The blood will move better. 09:40 If blood stays still, it has a tendency to clot. 09:43 So we identify a pulmonary embolism - a person usually has 09:47 chest pain, extreme shortness of breath that doesn't go away. 09:50 The way we diagnose that nowadays is we do usually a 09:54 CAT scan - we call that a CTA. 09:57 We put some dye into the vein arteries 09:59 of the pulmonary system. 10:01 Sometimes we do a blood test called a D-dimer. 10:03 and that tells us if they're having a pulmonary embolism. 10:06 So that's one you cannot miss. 10:09 Another one you can't miss is a pneumothorax, 10:13 and a pneumothorax is basically a hole in the lung. 10:17 And when a hole is in the lung, guess what happens... 10:19 All the air runs out of the lung and it squishes the lung. 10:23 The lung collapses. Yes, lung collapse. 10:25 And that can cause pain, terrible pain, 10:28 and it also is another cause of sudden death 10:31 is a pneumothorax. 10:32 So you can just pick that up with listening to the lungs 10:35 and an x-ray and sometimes it can be very subtle. 10:38 You know, they could have a small pneumothorax. 10:40 We see that in people that usually have a history of 10:42 trauma - some people that are real skinny or smoke cigarettes 10:46 are more prone to having just a small hole in their lungs, 10:49 the air leaks out and if enough leaks out, 10:52 it squishes the lung and that can lead to sudden death. 10:55 The treatment for that is a chest tube 10:57 to relieve the pressure, so we can get the air 10:59 out of the lung so it re-expands 11:01 and it doesn't cause another problem. 11:03 Another big problem that we see is what we call 11:05 "a dissection," and it's usually in the big artery 11:09 that leaves the heart because of dissection... 11:11 What a dissection is - is that artery just rips. 11:14 I don't know if you remember the actor named, 11:16 "John Ritter," but he had an aortic dissection 11:20 where it was ripping and it ripped back and it caused 11:22 him to have sudden death. 11:24 So the characteristic of that pain, of course, it's 11:27 chest pain, it can feel like it's burning going through 11:29 the back - we do a CAT scan on that type of pain, 11:32 and we found out that they have a dissection. 11:34 So you can't miss that one. 11:36 And then probably the most common cause is 11:38 chest pain that goes away that comes on exertion. 11:42 We call that "unstable angina." 11:45 It comes when you do things and goes away when you rest. 11:48 If we're not sure, we put them on a treadmill test. 11:50 There are some other tests we 11:52 can do to evaluate them having this because that could be 11:55 a potential heart attack if missed. Right 11:58 So those are 5 really big things that can cause death 12:01 pretty quickly if they're missed. 12:05 A lot of times when people come in, 12:07 they do not have those things, 12:08 but you can't afford to miss those 5 big causes 12:11 of pain above the rest, so if you're having 12:14 pain that won't go away, the take-home is 12:16 get to the emergency room, it could be something serious. 12:21 Chest pain isn't something worth risking. No 12:23 And you don't want to mess around at home and say, 12:25 "No, I'm going to be okay, it's not a big deal." 12:27 We don't really know that until we get checked out. Right 12:29 And those are some simple things that a lot of times 12:31 it's not serious, but you can't afford to miss it 12:34 because if it is, it could be life-threatening. Yeah 12:37 Well we're going to take a quick break 12:39 and we'll be back with Dr. Marcum 12:40 to discuss more about chest pains - so stay with us. |
Revised 2016-12-05