What's wrong with the tearing pain in my heart

The heart feels like it is tearing, which is most likely a manifestation of angina pectoris. Angina pectoris is a relatively dangerous disease for patients. If it is not treated actively and reasonably, it will threaten the patient's life safety. In addition, angina pectoris also has certain symptoms. Through these symptoms, patients can first check whether they have angina pectoris.

1. Location of angina

The typical location should be behind the sternum, but we often say that pain in the range from below the nose to above the navel may be a manifestation of angina pectoris, and not only pain in the left chest is angina pectoris, which also leads to misdiagnosis in many patients. Patients with toothache are often found to have severe coronary heart disease after repeated examinations. In addition, patients with "neck pinching" symptoms often have severe stenosis of the proximal coronary artery. There are also many patients with "stomach pain" and "stomach discomfort" all year round, who are also found to have severe coronary heart disease. Therefore, when I make rounds, I often tell patients that if they experience pain or discomfort in the area below the nose and above the navel, and they are at high risk of coronary heart disease (see "What kind of people are prone to coronary heart disease?" for details), they first need to rule out the possibility of coronary heart disease and angina pectoris, because other systemic diseases do not develop as quickly or cause as much harm as coronary heart disease, angina pectoris, and myocardial infarction. This is crucial. In addition, the location of angina pectoris is generally not a "point". Patients should not be able to accurately point out the pain point, but rather a "pattern" of discomfort. Massage or finger pressure will not improve the symptoms.

2. Causes of angina pectoris

Depending on the cause, angina pectoris can be divided into stable angina pectoris and unstable angina pectoris. The most common cause of stable angina is fatigue, which is also the easiest to understand. Patients experience angina symptoms after strenuous activities (such as climbing stairs, running, climbing uphill against the wind, etc.). Other causes include emotional excitement, cold stimulation, fullness, fright, etc. Angina pectoris that occurs in a quiet state is the most dangerous manifestation of unstable angina pectoris, which often means that there is a ruptured plaque in the coronary artery and needs to be treated in the hospital as soon as possible.

3. Nature of angina pectoris

The typical symptoms should be a squeezing and tightness behind the sternum. Patients often need to "squat on the ground with their hands on their hearts" to rest. Other symptoms include a feeling of a large stone pressing on the chest, chest tightness, shortness of breath, and shortness of breath. They are often only manifested as headaches, stomach pains, or general discomfort, etc., and generally do not manifest as transient "needle-like" or "knife-like" pain. In addition, there is completely asymptomatic angina pectoris, which often occurs in patients with long-term diabetes. In clinical practice, we often encounter patients with persistent chest tightness and who like to "exhale deeply" or "breathe deeply". They are often female patients. In the end, coronary heart disease is ruled out and most of them are considered to have cardiac neurosis.

4. Duration of angina

Angina pectoris usually lasts from a few minutes to no more than 20 minutes. We often say that if chest discomfort lasts for a few seconds or more than half an hour, we do not consider the possibility of angina pectoris. In clinical practice, we often encounter patients with intercostal neuralgia or frozen shoulder. The pain is severe and persistent, which are not manifestations of angina pectoris. In addition, for elderly people with herpes zoster, persistent chest pain attacks are often easily misdiagnosed as angina pectoris before skin lesions occur, which requires our attention.

5. Outcome of angina pectoris

Angina pectoris can be relieved within a few minutes after resting or taking nitroglycerin sublingually. If it is exertional angina, the angina will continue to occur if you continue to move after the angina is relieved. This is why we often encounter patients who need to rest 3 or 4 times after climbing 5 floors. For patients with resting angina pectoris, repeated attacks often indicate an impending myocardial infarction, so timely medical treatment is crucial.