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(Circulation. 2002;106:530.)
© 2002 American Heart Association, Inc.

Cardiology Patient Page

Chest Pain

Joan Kirschenbaum Cohn, DSW; Peter F. Cohn, MD

From the Mt Sinai School of Medicine, New York (J.K.C.) and the Stony Brook University Health Sciences Center (P.F.C.), Stony Brook, NY.

Correspondence to Peter F. Cohn, MD, Stony Brook University Health Sciences Center, Stony Brook, NY 11794. E-mail pcohn@ha.uh.sunysb.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

All that glitters is not gold" is a familiar saying. Similarly, all that is called chest pain is not necessarily a result of heart disease. The association between chest pain (angina pectoris^*) and heart disease goes back to its initial description by Heberden in 1772. His description was of a "strangling sensation in the chest." Although angina pectoris is not the only symptom of heart disease, it is the most common one and is a good place to begin a brief discussion of cardiac pain.

Chest Pain and Heart Disease

An intriguing question that has puzzled both physicians and the lay public concerns the relationship between injury to an internal organ and the sensation of that injury perceived by patients as arm, chest, back, or jaw pain. The transmission of the pain impulse from the heart to the brain via the spinal cord is still not completely understood. Because the location in the spinal cord area in which pain signals from the heart are received is located near areas in which similar pain signals for the chest wall and arms are received, it is believed that "spillover" in these spinal cord areas is responsible for the perception of the cardiac discomfort in the arms, chest, and occasionally the back.

Patients usually are not aware of injuries to internal organs unless the affected organ swells, causing pressure on nerve endings, and these nerve fibers then transmit pain impulses to the brain. This neurological pathway is true of the liver, lung, intestines, and heart. In the . . . [Full Text of this Article]