Participants: Nick Evenson (Host), Dr. James Marcum
Series Code: UP
Program Code: UP000080B
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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. |
Revised 2016-12-05