People often feel pain in the precordial region in daily life and always worry if it is a heart attack. We often encounter such patients in outpatient clinics, asking them where they are not feeling well, and they will tell you directly “I have angina”, making a diagnosis for themselves. So what is angina? Is anterior heart pain angina? In fact, there are many causes of anterior heart pain, and the most common ones are not angina, but muscle and soft tissue injury and esophageal acid reflux. However, angina pectoris and myocardial infarction, aortic coarctation and pulmonary tethering due to severe cardiac coronary artery sclerosis often lead to serious consequences and are thus a cause for concern. Other conditions such as acute pericarditis, pleurisy, pneumonia, etc. can also cause pain in the precordial region. The pain in the precordial region due to coronary artery disease is mostly associated with activity and exertion. The symptoms are relieved quickly after rest. Sometimes it is accompanied by pain radiating to the neck and shoulders, shortness of breath, dizziness, and weakness. The presence of these symptoms should be taken seriously. Especially when men are older than 45 and women are older than 55.
Patients with family history, smoking history, hypertension, hyperlipidemia, diabetes mellitus and other risk factors should be further investigated. Non-invasive and invasive tests are available, and depending on symptoms, risk factors and ECG and blood tests, the doctor will recommend a specific test. Non-invasive methods include exercise panels, exercise panels or drug-induced plus imaging methods such as exercise or drug cardiac ultrasound, exercise or drug nuclear medicine, drug-induced cardiac magnetic resonance, and
CT
coronary angiography. Each test has its advantages and disadvantages. Briefly, the sensitivity of a single exercise panel test is relatively low, 55-60%. The addition of imaging methods can significantly improve sensitivity and specificity. Nuclear medicine examinations are widely used, but have radiation exposure and should not be repeated too many times.
Cardiac ultrasound is convenient and economical, without radiation exposure, but is less sensitive to small ischemia and sometimes image quality is affected by soft tissue scars, lung and obesity. Cardiac MRI offers the highest specificity and sensitivity without radiation exposure, but has higher technical requirements and is not available in every hospital. Cardiac
CT angiography provides a clear coronary diagnosis, especially for normal coronary vessels. With a clear diagnosis, treatment is easier. The development of thoracic aortic aneurysm is a chronic process. Although diagnostic tools include cardiac MRI or cardiac CT, follow-up is needed to ensure that the aneurysm does not grow more than 0.5 cm per year or that the aneurysm is less than 5.5 cm.
The aortic aneurysm may be less than 5.5 cm per year, or less than 4.5-5 cm if the patient has congenital Bicuspid aortic office or Marfan’s syndrome. These are indications for surgical repair. Pulmonary artery thrombosis is also a common and high-risk acute condition. It is usually an acute condition due to the dislodgement of a lower extremity thrombus into the lung. It is commonly seen in people with lower extremity surgery, prolonged bed rest, tumors and abnormal blood coagulation. Chest CT
or nuclear medicine with blood tests and ultrasound of the lower extremities often provide an easy diagnosis. Anticoagulation therapy should be started as soon as possible. Other precordial pains are rarely life-threatening. The vast majority of precordial pain is nonspecific, such as soft tissue injury and esophageal reflux, and can be investigated and treated accordingly.