Does coronary heart disease always cause chest tightness and chest pain?

  This is an example from my own experience. I was a resident at that time, and one day I was on duty, about 5:00 p.m. The nurse asked me to go to the emergency consultation of the obstetrics and gynecology department. I ran downstairs in a hurry, and my colleagues from the emergency department, critical care medicine, and cardiology were already there. They were doing CPR. “It’s a patient in cardiac arrest, amniotic fluid embolism?” That was my first thought. When I saw the patient, I noticed it was a male patient in his 70s. Despite my doubts, I immediately took over and performed cardiac compressions. While resuscitating, I gradually figured out what was going on. It turned out that the patient was the father of a doctor here who had been feeling sick to his stomach for a long time, and this time, feeling pain in his stomach again, he came to the hospital to see his daughter, who is a doctor. Her daughter is a very famous professor of obstetrics and gynecology in our hospital and was in surgery at the time. She arranged for her father to rest in her office and planned to take him for a gastroscopy as soon as she finished the surgery. Unexpectedly, before she could get off the operating table, word came that her father went into shock and fainted. The electrocardiogram suggested an extensive inferior wall infarction.  Resuscitation that night lasted until after 10:00 p.m. His daughter is the chief of obstetrics and gynecology, whom we respect very much, and is very accomplished in her field of expertise. Now, faced with her father’s condition, she was at a loss for words and just kept saying over and over again, “He kept saying it was stomach pain, and I kept thinking he was having stomach discomfort, who would have thought it would be a heart problem.” Although none of us wanted to give up, the old man eventually left us with great regret. That afternoon, he said goodbye to his partner and came to the hospital alone, but he didn’t expect to be dead in just a few hours. Coronary heart disease is a time bomb for this old man, when he had a heart attack, the rescue was not untimely (he was in the hospital at the time, resuscitated in situ), the treatment was not ineffective (cardiology, surgery, emergency department, critical care medicine all present), but once the onset, there is still a very high mortality rate.  Many people have always thought that only chest or heart symptoms would suggest heart problems. For coronary heart disease, most people are still only above the awareness of typical angina, like this OB/GYN. In reality, however, most patients with coronary artery disease do not present with typical anterior heart pain. Some present with stomach pain, especially when the lower wall of the heart is ischemic; some present with toothache, some present with chest tightness and pressure; some will present with breath-holding and neck tightness.  Coronary heart disease is clinically divided into five types: occult, angina pectoris, myocardial infarction, heart failure (ischemic cardiomyopathy), and sudden death. The most common type is angina pectoris, and the two most serious types are myocardial infarction and sudden death.  Angina is a group of syndromes caused by acute temporary myocardial ischemia and hypoxia: (1) pressure and suffocation in the chest, stuffiness, severe burning pain, usually lasting 1-5 minutes, occasionally up to 15 minutes, which can be relieved by itself; (2) pain often radiates to the left shoulder, the left arm anterior medial side to the little finger and ring finger; (3) pain when the burden on the heart increases (such as increased physical activity, excessive (3) Pain occurs with increased cardiac stress (e.g., increased physical activity, excessive mental stimulation, and cold) and disappears after a few minutes of rest or sublingual nitroglycerin; (4) Pain attacks may be accompanied (or not) by symptoms of weakness, sweating, shortness of breath, apprehension, palpitations, nausea, or dizziness.  Myocardial infarction is a critical symptom of coronary artery disease, usually based on frequent and aggravated angina attacks, but there are also cases of sudden myocardial infarction without a history of angina (this is the most dangerous situation, often resulting in sudden death due to lack of preparedness). The presentation of myocardial infarction is: (1) sudden onset of severe pain in the retrosternal or precordial region, radiating to the left shoulder, left arm, or elsewhere, and lasting more than half an hour, unrelieved by rest and nitroglycerin; (2) shortness of breath, dizziness, nausea, excessive sweating, and a weak pulse; (3) cold, clammy, gray, and gravely ill skin; and (4) syncope or shock as the only presentation in about one in ten patients.  For those patients with risk factors, relevant tests should be performed as early as possible to exclude coronary artery disease to avoid further damage. The common predisposing groups are: (1) Men over 45 years of age, women over 55 years of age or postmenopausal; (2) Fathers and brothers who died of heart disease before the age of 55 and mothers/sisters before the age of 65; (3) People with high LDL-C and low HDL-C and those with hypertension, urinary glucose disease, smoking, overweight, obesity, gout, and inactivity.