Have you ever felt a
sharp pain in your chest,
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or maybe a dull burning, aching
or tight squeezing sensation?
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Well on today's
program, we'll be discovering
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the root of the
problem, so stay tuned...
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I'm Dr. James
Marcum, are you interested in
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discovering the reason why?
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Do you want solutions
to your healthcare problem?
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Are you tired of
taking medications?
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Well, you're about to be given
"The Ultimate Prescription"
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The first thing that most
people associate with chest pain
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is a heart attack,
but there are many more
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things that can
cause it... your lungs,
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esophagus,
muscles or even your ribs.
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So how do you know
when it's chest pain
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that you need to be worried
about - if it's a heart attack?
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Well, Dr. Marcum is here
and welcome to the program,
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and Dr. Marcum, tell us a
little bit about chest pain.
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It's something you
see every day, correct?
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Yeah, chest pain, Nick,
is something I see every day.
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It's how I make my living is
seeing patients with chest pain.
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And, you know, we've been
talking about different pains
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in different parts of the
body in our series on pain...
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And today, we're going to focus
on pain above the diaphragm
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with chest pain,
basically above the diaphragm,
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and below the neck.
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And, the reason I think this
is so important is because we
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talked about different
types of pain and any pain
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above the diaphragm could be
potentially life-threatening,
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and we want to help our
listeners and viewers know
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when they should
be very concerned,
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when maybe they
shouldn't be so concerned,
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and what they
should do when they
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have pains above the diaphragm.
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So I think this is a
very interesting subject,
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something I do every day.
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Yeah, and in this
series, we're going to cover
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a bunch of
different kinds of pain.
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Today, we're
covering chest pain,
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but we're going to talk
about pain from different areas,
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the back, the
head, different areas...
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But today we're talking
specifically about chest pain,
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and how do you know, as
a patient, how do I know
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when I need to come see
you for all the chest pain.
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That's what we're
going to talk about
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during the
course of the program.
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It's a very complex
subject and it's something that
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we have a clip that
we're going to show about
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some of the general
approaches and some of the tools
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we have to evaluate
this once people do come,
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and then after that
clip, I will get an answer
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to that question
that you just gave me.
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It's going to take a long time,
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probably the rest of
the program to answer.
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All right, well we recently
took our cameras to Dr. Marcum's
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office to see some of the
tools that he uses in helping
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to diagnose chest
pain, let's have a look!
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Chest pain can be
caused by many things.
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Of course the most
concerning is the heart,
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but in this area we have
the heart, we have muscles,
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we have the
lungs, we have nerves,
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we also have the
esophagus and stomach contents
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that sometimes has
caused chest pain as well.
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So the first thing I do
is do what we call a history
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and the physical.
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That's where I sit down
with the patient and basically
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ask them a lot of questions
regarding the chest pain.
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When did it start?
How long did it last?
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Where does it
radiate? What makes it worse?
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What makes it better?
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Then I examine the
patient and this would include
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taking a blood pressure,
feeling their heartbeat,
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listening to their
heart, pressing on parts,
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and getting information.
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So the history guides me to
what physical exam I need to do
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to confirm my diagnosis or not.
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Then the next thing is we have
a bunch of diagnostic tools.
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Almost everyone that
comes in to the office get an
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electrocardiogram, an EKG.
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This tells me about
the rhythm of the heart.
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The characteristics of
this might tell me if there
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has been an old heart attack;
if there's a dangerous rhythm;
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the size of the chambers.
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Usually, we also get an x-ray.
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A chest x-ray is very valuable.
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It lets me know if the
heart has been damaged,
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if the heart is enlarged.
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It also lets me
look at the lungs in case
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the lungs might
be causing the pain.
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If I still need
more information,
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then another test I
might do is a treadmill test
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where we walk
them on the treadmill.
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If the pain
comes back on exertion,
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that's very characteristic
of what we call "angina"
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where the heart is
not getting enough blood.
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Not only do we have the
treadmill where we can look at
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the EKG and ask the patient
if he hurts when he does things,
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we also have some fancy imaging.
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We have the echocardiogram
where we look at the muscle
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to see how it
performs when they exercise.
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We also have a nuclear
scan where we put in isotope
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that goes throughout the heart,
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and we can look at
characteristic patterns.
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Of course if we think it's due
to the arteries of the heart,
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we have a more advanced test
called a heart catheterization
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where we put dye inside
the heart to see if a person
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might benefit from having
a stent or a bypass surgery.
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So, in general, when
it's due to the heart,
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there are a
couple of characteristic
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pains I want
you to know about...
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If a pain that's above
your waist or a discomfort
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that will not go away,
that could be a heart attack.
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So you need to get to
the emergency room right away
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to get an EKG, maybe
to do some biomarkers,
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that's blood work to see
if your heart is damaged.
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If a pain happens when
you do something and goes away
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when you rest, that's also
characteristic of the heart
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because the heart
hurts when it does something,
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and it goes away when you rest.
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If it hurts when you
take a deep breath or breathe,
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that could be
related to lungs or muscles.
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If it hurts when
you lay down at night,
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that could be related to acid.
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And then there's all
sorts of pains in between.
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So this is just a brief
overview of causes of chest pain
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and some of the diagnostic tools
I use to evaluate the heart.
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You know, Dr. Marcum,
that was very interesting
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to see some of the
tools that you use every day,
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and, you know, I haven't
experienced chest pain myself,
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so it was really neat
to see some of the tools.
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Almost everyone sooner
or later usually has pain
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above the waist, above
the diaphragm and the reason
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it's so serious is if
you're having a heart attack
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and it's undetected - that's
potentially life-threatening.
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So the place to go, if
you have pain that you don't
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know where it is, is
to go to the hospital;
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get evaluated quickly because
now we have the technology
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that if you are having
a heart attack, we can go
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up inside the heart...
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We can open up that blood
vessel usually with a stent,
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then you can receive
more blood and then we can
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abort you losing that
heart muscle and abort the
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dangerous things that
happen, the dangerous rhythms...
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And every year, you hear someone
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that dies suddenly
from a heart attack.
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And a lot of
people don't realize it,
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but half of all people
don't find out that they have
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heart disease until they
have the heart attack. Right
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It's very much a
hidden disease, Nick.
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It's a disease that
we accumulate over time,
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and we get heart
disease because of our diets.
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You know, we eat
these high fat diets.
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If you eat more than 15 to
20% of your calories in fat,
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it's stored. Right
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It's stored in the arteries,
not only the heart arteries,
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but arteries all over the body.
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It could be stored as fat and
if it's accumulated over time,
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sooner or later it
can cause a problem.
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And, of course, the
largest problem in the heart
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is a heart attack.
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So a lot of people say,
"Oh, I've never had pain before,
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this is not a heart attack, it's
my stomach or something else."
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But sometimes you cannot
tell the difference between
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reflux pain and
heart attack pain.
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Now frequently, when
you're having a heart attack,
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there are multiple symptoms.
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You know, there is also having
pain that's feels like something
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is crushing you;
you might not be able to
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breathe well; you
might have palpitations.
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Usually there's something
else that goes with it,
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but any pain that
you're not sure of,
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I think you'll really have to
get to the hospital right away.
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Now the people
that come to my office,
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are the people that
have stable pain. Okay
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They're not having pain
every single second. Right
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So the first point today
that we want to leave all of our
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viewers with - if
you are having pain,
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you don't know
where it's coming from,
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you need to get to the
emergency room right away.
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It could save your life. Yeah
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So there's heart disease
and there's heart attacks,
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what are some other
acute causes of chest pain?
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Well, when I have an intern
or someone working with me,
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I sort of give them the
5 big causes of chest pain
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that they have to
evaluate for right away. Okay
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So let's say you're having chest
pain and it won't go away...
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Okay, well one of the
things that we have to know
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right now - before we
can even let you out of
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the emergency room - the
first one is a heart attack.
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We do that with EKGs and we
use some blood work with that.
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If you are
having a heart attack,
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we take you to
the angiography suite,
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we try to open up that
artery right now - can't wait.
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If you miss a heart
attack, this person could have
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sudden death - so
it's very, very important.
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Another cause is a
pulmonary embolism,
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and a pulmonary
embolism is a clot that comes
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usually from the legs or
lower extremities and it goes
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into the lungs and it
can cause a major issue,
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and you can have sudden
death from a pulmonary embolism.
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We've heard some
stories, through the years,
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of people that sit for a
prolonged period of time,
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they don't move their legs.
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They get clots in their
legs, the clot breaks off,
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goes to the
lungs and kills them.
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Sometimes we see that
in a hospitalized patient,
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the patient that
doesn't move around very much.
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That's why I tell everyone,
every hour, you need to move
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around - move those legs.
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It helps the bowels
move, it helps to break up.
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The blood will move better.
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If blood stays still,
it has a tendency to clot.
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So we identify a pulmonary
embolism - a person usually has
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chest pain, extreme shortness
of breath that doesn't go away.
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The way we diagnose that
nowadays is we do usually a
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CAT scan - we call that a CTA.
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We put some dye
into the vein arteries
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of the pulmonary system.
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Sometimes we do a
blood test called a D-dimer.
00:10:01.26\00:10:03.80
and that tells us if they're
having a pulmonary embolism.
00:10:03.83\00:10:06.94
So that's one you cannot miss.
00:10:06.97\00:10:09.74
Another one you can't
miss is a pneumothorax,
00:10:09.77\00:10:12.94
and a pneumothorax is
basically a hole in the lung.
00:10:13.41\00:10:17.61
And when a hole is in the
lung, guess what happens...
00:10:17.65\00:10:19.71
All the air runs out of the
lung and it squishes the lung.
00:10:19.75\00:10:23.89
The lung
collapses. Yes, lung collapse.
00:10:23.92\00:10:25.79
And that can cause
pain, terrible pain,
00:10:25.82\00:10:28.06
and it also is
another cause of sudden death
00:10:28.09\00:10:31.39
is a pneumothorax.
00:10:31.43\00:10:32.76
So you can just pick that
up with listening to the lungs
00:10:32.79\00:10:35.43
and an x-ray and
sometimes it can be very subtle.
00:10:35.46\00:10:38.53
You know, they could
have a small pneumothorax.
00:10:38.57\00:10:40.50
We see that in people
that usually have a history of
00:10:40.54\00:10:42.90
trauma - some people that are
real skinny or smoke cigarettes
00:10:42.94\00:10:46.17
are more prone to having just
a small hole in their lungs,
00:10:46.21\00:10:49.41
the air leaks out
and if enough leaks out,
00:10:49.44\00:10:52.05
it squishes the lung and
that can lead to sudden death.
00:10:52.08\00:10:54.98
The treatment for
that is a chest tube
00:10:55.02\00:10:57.09
to relieve the
pressure, so we can get the air
00:10:57.12\00:10:59.42
out of the lung so it re-expands
00:10:59.45\00:11:01.39
and it doesn't
cause another problem.
00:11:01.42\00:11:03.16
Another big problem
that we see is what we call
00:11:03.19\00:11:05.53
"a dissection," and it's
usually in the big artery
00:11:05.56\00:11:09.03
that leaves the heart
because of dissection...
00:11:09.06\00:11:11.17
What a dissection is -
is that artery just rips.
00:11:11.20\00:11:14.50
I don't know if you
remember the actor named,
00:11:14.54\00:11:16.77
"John Ritter," but he
had an aortic dissection
00:11:16.81\00:11:19.97
where it was ripping and
it ripped back and it caused
00:11:20.01\00:11:22.84
him to have sudden death.
00:11:22.88\00:11:24.31
So the characteristic of
that pain, of course, it's
00:11:24.35\00:11:26.98
chest pain, it can feel
like it's burning going through
00:11:27.02\00:11:29.58
the back - we do a CAT
scan on that type of pain,
00:11:29.62\00:11:32.62
and we found out that
they have a dissection.
00:11:32.65\00:11:34.49
So you can't miss that one.
00:11:34.52\00:11:36.16
And then probably
the most common cause is
00:11:36.19\00:11:38.96
chest pain that goes
away that comes on exertion.
00:11:38.99\00:11:42.73
We call that "unstable angina."
00:11:42.76\00:11:45.53
It comes when you do things
and goes away when you rest.
00:11:45.57\00:11:48.30
If we're not sure, we
put them on a treadmill test.
00:11:48.34\00:11:50.64
There are some other tests we
00:11:50.67\00:11:52.01
can do to evaluate them having
this because that could be
00:11:52.04\00:11:55.04
a potential heart
attack if missed. Right
00:11:55.08\00:11:58.08
So those are 5 really big
things that can cause death
00:11:58.11\00:12:01.72
pretty quickly
if they're missed.
00:12:01.75\00:12:03.89
A lot of times
when people come in,
00:12:05.65\00:12:07.22
they do not have those things,
00:12:07.26\00:12:08.76
but you can't afford
to miss those 5 big causes
00:12:08.79\00:12:11.79
of pain above the
rest, so if you're having
00:12:11.83\00:12:14.60
pain that won't go
away, the take-home is
00:12:14.63\00:12:16.77
get to the emergency room,
it could be something serious.
00:12:16.80\00:12:21.24
Chest pain isn't
something worth risking. No
00:12:21.27\00:12:23.41
And you don't want to
mess around at home and say,
00:12:23.44\00:12:25.07
"No, I'm going to be
okay, it's not a big deal."
00:12:25.11\00:12:27.28
We don't really know that
until we get checked out. Right
00:12:27.31\00:12:29.28
And those are some simple
things that a lot of times
00:12:29.31\00:12:31.35
it's not serious, but
you can't afford to miss it
00:12:31.38\00:12:34.18
because if it is, it
could be life-threatening. Yeah
00:12:34.22\00:12:37.09
Well we're going
to take a quick break
00:12:37.12\00:12:39.02
and we'll be
back with Dr. Marcum
00:12:39.05\00:12:40.92
to discuss more about
chest pains - so stay with us.
00:12:40.96\00:12:43.89