Chest pain due to CAD


By Dr. Blair MacPhail


Chest pain due to coronary artery disease is a very individualized symptom. Some people experience the typical pressure in the mid-substernal area of the chest radiating to the jaw, arms, throat or back, and may be associated with shortness of breath, nausea and vomiting or sweating. Others may have less typical symptoms or nonspecific subtle symptoms, such as extreme fatigue. This is referred to as “silent” CAD and is less common. Women tend to have less typical types of chest pain that involve the back.

Risk factors for CAD include diabetes mellitus, hypertension, hyperlipidemia, family history and tobacco abuse. Modify these risk factors by quitting smoking. Help prevent the development of CAD by aggressively reducing low-density lipoprotein cholesterol (through medicine such as statins), exercise and controlling hypertension and diabetes.

CAD can present suddenly such as a heart attack, or more slowly, sometimes starting as a symptom with exercise or activity relieved by rest. If someone develops a sudden persistent chest pain, or associated symptoms, we recommend going to the emergency room of a nearby hospital to obtain a history/physical, electrocardiogram and blood work to rule out a heart attack. Intermittent forms of chest pain or other symptoms can be evaluated with a history/physical and a variety of screening tests. These may include a treadmill testing, or a form of cardiac exercise with intravenous medicine. We often use echocardiogram or nuclear scan to image the heart before and after exercise (or IV infusion of medicine) to make the stress test more accurate.

Coronary artery disease is a common problem and can be prevented in many people. If you are having chest pain symptoms, go for an evaluation. To help prevent CAD, get your cholesterol checked, don’t smoke, maintain a healthy weight and blood pressure and perform some form of aerobic exercise four times a week.


Dr. Blair MacPhail is a cardiologist with Heart Partners of Indiana.