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Chest Pain Clinic

What is the occurrence (rate of incidence) of Chest pain?

    • 20-40% of all medical admissions are for acute chest pain.
  • Coronary heart disease remains the principal cause of death in the UAE and a fifth of these deaths occur below retirement age.
  • The main risk factors are smoking, hypertension, hyperlipidemia, diabetes and obesity

 

Appearance or Presentation of Chest pain

  • Chest pain due to cardiac ischemia typically tends to be retrosternal or epigastric, tight and crushing in quality, and may radiate to the arms, shoulders, neck or jaw.
  • Aortic dissection tends to cause pain with a tearing quality; pericarditis and pulmonary pain tend to be worse on inspiration (pleuritic) and esophageal reflux pain has a burning quality.
  • Stable angina is likely if chest discomfort or breathlessness is associated with effort, emotion, food or cold weather, symptoms are relieved by rest and/or glyceryl trinitrate (GTN) and one or more risk factors for coronary artery disease are present.  such as smoking history, past history of cardiovascular disease and comorbidities, especially diabetes, hypertension and hyperlipidemia
  • In patients with acute coronary syndrome
    • Chest pain may be associated with sweating, nausea, vomiting, dyspnea, fatigue, and or palpitations
    • Shortness of breath may be the main symptom of cardiac ischemia, associated with angina pain, or a symptom of heart failure
    • Atypical presentations are common (especially in women, older men, people with diabetes, and people from ethnic minorities), e.g. abdominal discomfort or jaw pain; elderly patients may present with altered mental state.

Examination:  Many patients will have entirely normal examination findings. However, a thorough cardiovascular examination is essential.

 

Common causes of Chest pain (Differential diagnosis)

Chest pain can be cardiac as well as non-cardiac too. The main causes of chest pain include:

  •  Angina, acute coronary syndrome (ACS) (including myocardial infarction).
  • Acute pericarditis
  • Pneumonia, pulmonary embolus, pneumothorax
  • Gastro-esophageal reflux, esophageal spasm
  • Peptic ulcer disease
  • Gallstones, cholecystitis
  • Acute pancreatitis
  • Chest wall pain, e.g. Tietze's syndrome, trauma, shingles, rib secondaries, osteoporosis
  • Aortic dissection
  • Anxiety, depression

 

Investigations needed for Chest pain

Depending on the clinical state of the patient and any suspicion of myocardial infarction, the patient may require immediate transfer to hospital before any investigations are performed.

  • Investigations may be required to exclude non-cardiac causes of chest pain, e.g. chest X-ray (pneumonia), abdominal ultrasound (gallstones), serum amylase (acute pancreatitis)
  • Initial blood investigations include cardiac enzymes, fasting lipids, fasting glucose and full blood count (to exclude anemia, and high white cell count may suggest pneumonia)
  • Resting ECG - a resting ECG is normal in over 90% of patients with recent symptoms of angina
  • Chest x-ray - this may be useful in evaluating the presence of heart failure or an alternative diagnosis, e.g. aortic aneurysm, pneumonia, rib fractures, rib secondaries or osteoporosis
  • Exercise ECG testing should not be used to diagnose or exclude stable angina for people without known coronary artery disease. See separate article on angina pectoris for further discussion on diagnosis of angina
  • Depending on the presentation, further investigations may include echocardiogram,coronary angiography, V/Q scan or pulmonary angiography (pulmonary embolus), CT aortography (aortic dissection) or upper gastrointestinal endoscopy (gastro-esophageal reflux disease, peptic ulcer)

 

What does NMC Chest Pain clinic do?

  • For those patients not requiring immediate hospital admission, chest pain clinics enable rapid confirmation of the diagnosis, initiation of treatment, and, where considered appropriate, further investigation and intervention
  • Our Chest pain clinic encouraged, that prompt assessment and management actually reduces cardiac morbidity and mortality
  • Patients should understand that further assessment may lead to a recommendation for more invasive treatment

 

NMC Medical Centre, Deira - Dubai

Dr. Anjana Asokan Nair

Dr. Anjana Asokan Nair

Hod - specialist cardiology,
Dubai

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Dr. Dharmarajan Dhanapalan

Dr. Dharmarajan Dhanapalan

Specialist cardiologist,
Dubai

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NMC Specialty Hospital - Abu Dhabi

Dr. Dinesh Ramagowdanpura Sadasivan

Dr. Dinesh Ramagowdanpura Sadasivan

Hod and consultant cardio thoracic surgery,
Abu Dhabi

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Dr. Mohamed Muthiullah

Dr. Mohamed Muthiullah

Specialist cardiology,
Abu Dhabi

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Dr. Vishnu Vageesa Sharma

Dr. Vishnu Vageesa Sharma

Specialist physician,
Abu Dhabi

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Dr. Paul Stanley Thoppil

Dr. Paul Stanley Thoppil

Interventional cardiologist,
Abu Dhabi

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NMC Royal Hospital, Khalifa City - Abu Dhabi

Dr. Dinesh Ramagowdanpura Sadasivan

Dr. Dinesh Ramagowdanpura Sadasivan

Hod and consultant cardio thoracic surgery,
Abu Dhabi

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Dr. Wissam Al Sahli

Dr. Wissam Al Sahli

Consultant interventional cardiologist,
Abu Dhabi

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NMC Day Surgery, MBZ - Abu Dhabi

Dr. Mohamed Muthiullah

Dr. Mohamed Muthiullah

Specialist cardiology,
Abu Dhabi

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Dr. Wissam Al Sahli

Dr. Wissam Al Sahli

Consultant interventional cardiologist,
Abu Dhabi

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NMC Specialty Hospital - Al Ain

Dr. Pradeep Chand Sukumaran Nair

Dr. Pradeep Chand Sukumaran Nair

Consultant cardiothoracic surgery,
Al Ain

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Dr. Fady Aziz Gerges

Dr. Fady Aziz Gerges

Specialist cardiovascular disease,
Al Ain

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Dr. Austin Mohan Komaranchath

Dr. Austin Mohan Komaranchath

Specialist interventional cardiologist,
Al Ain

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NMC Specialty Hospital - Dubai

Dr. Abbas Hamid Al Shareefi

Dr. Abbas Hamid Al Shareefi

Consultant cardiologist,
Dubai

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Dr. Girishchandra Varma

Dr. Girishchandra Varma

Specialist cardiothoracic surgeon,
Dubai

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Dr. Kais Mrabet

Dr. Kais Mrabet

Interventional cardiologist,
Dubai

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Dr. Upendra Jayantilal Shah

Dr. Upendra Jayantilal Shah

Specialist interventional cardiologist,
Dubai

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Dr. Dharmarajan Dhanapalan

Dr. Dharmarajan Dhanapalan

Specialist cardiologist,
Dubai

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B R Medical Suites - Dubai

Prof. Dr. Uwe Klima

Prof. Dr. Uwe Klima

Consultant cardiac, thoracic and vascular surgeon,
Dubai

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New Medical Centre - Sharjah

Dr. Sameh Mounir Nessim Tayab

Dr. Sameh Mounir Nessim Tayab

Specialist cardiologist,
Sharjah

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