Hypertension
(high blood pressure) as a cause of chest pain in both men and women is listed first because it is the single most common cause of chest pain, including coronary artery disease itself. In other words, more people suffer from chest pain due to high blood pressure than those who have chest pain because of obstructive coronary artery disease. Considering the fact that 64 million people in this country have hypertension, and approximately 75% of them are either unaware of its presence, or are not adequately treated, it is not hard to understand why so many individuals with high blood pressure are having chest pain.Although it is a long known fact that hypertension can cause chest pain, it is not a commonly known fact. Indeed, most doctors including cardiologists seem to be completely unaware of it. Complicating this lack of awareness on the part of doctors is the fact that hypertension may exist for years with both patient and doctor being unaware of its presence. This is because typically such patients will have a rise in their blood pressure only during periods of stress or extraordinary physical activity. At rest, or in the absence of stress, their blood pressure is normal. Thus, their blood pressure is apt to be normal during a routine office examination in which blood pressure is typically taken while the patient is at rest. Eventually the blood pressure of such patients will become elevated even at rest, but not until there has been extensive damage to the kidneys, heart, vascular system and brain. This is why hypertension has been called the "silent killer."
The mechanism of an elevated blood pressure causing chest pain is similar to the changes that occur when a blood pressure cuff around the arm is inflated. The pressure within the cuff is transmitted to the arm itself, and directly to the brachial artery within the arm. When the pressure within the cuff becomes greater than the pressure within the artery, the artery will collapse and blood flow will stop. In the case of the heart, when the blood pressure is elevated, that pressure is transmitted back to the cavity of the left ventricle. The increase in pressure is transferred to the heart muscle itself. When the transmitted pressure within the heart wall is great enough, it will cause the small coronary arteries within the muscle, that are branches and smaller in diameter than the surface coronary arteries, to collapse. Therefore, blood flow within the muscle will be reduced or cease altogether, and chest pain will result.
It should be apparent that if an individual is having chest pain, and a resting blood pressure is normal, and that patient is made to undergo angiograms, coincidental coronary artery disease may well be found. The cardiologist is likely to conclude that it is the coronary artery disease that is responsible for the patient's symptoms. In such a situation, the patient should purchase a blood pressure cuff, and take his own blood pressure during episodes of his chest pain. If he finds his blood pressure is elevated, then he should insist that his blood pressure be brought down to normal with medications. Obviously, if medication causes his blood pressure to return to normal, and his chest pain disappears, then he doesn't need angioplasty or coronary artery bypass surgery. Finally, it would make sense to investigate the cause of your chest pain before undergoing angiograms. See additional causes below.
