Chest pain due to stress: a daily dose of remedy

Two days ago, my dear sister opened up her new foodcart business. This was a biz long been dreamed of and a product of long hours of overtime and "on the side rackets". She encountered a lot of problems alongside, but what the heck, this is the moment we are all waiting for. The soft opening day. Come the 8th of January, she chose this date because of the significance of the number. Both feng shui and all the stars in the heavens agreed that it was a good day to start up anything new. She and her boyfriend was up early to man the stall on its opening day. My dad geared up the place with enough sound system and blinking lights to draw more attention to the passersby. We would have hired a mascot but that was too much to ask. 2pm hit the clock and there it was. Long piles of customers were waiting for their turn just to get a taste of what this food cart has to offer. We were all happy to see satisfied customers burping their heart out. But what we were more inquisitive about is how much my sister earned on her first day. It was practically 6 hours after when she declared "Quota". She was forced to close her stall because she ran out of raw stocks. So thats is for the day folks. She earned more than what she prayed for to Our Lady. She is hoping to get just the same everyday onwards.

The dreadful days come, the following day, then the next day and the next day...There were no more piles of people lining, no more satisfied customers. What seems to be wrong? I got a text from my sister the 5th day after first soft opening. She just texted an icon and its the crying icon. I did not know what to do. Until, she called me crying saying she has been having the chest pain all day. That pain kept her from working well on her office, and caused her to ask a rest hour from her office clinic. I was indeed worried. As an older sister and the physician in the house, a lot of things pan around my head. What if she is having real anginal pain? What if she is suffering from a heart attack or some valvular heart problem. Man she is only 26!

Alright enough worries. I doodled the scenario in my head. She is a very young professional, medium built, eats all the food she wants without gaining weight, she does not exercise but frequently walk the roads of Ayala Ave end to end everyday, she does not smoke nor drink. So what is her predisposition of getting a heart problem when she is not at all prone to get it? Hmmm then I remembered, she has been having a lot of trouble saving the little biz she started some 5 or 6 days ago. What can this do to you and your health? Studies have shown that, stress nowadays is the number one cause of heart attacks both in mid adult to adult age range. Can this be real chest pain? What could be the possible causes of Chest Pain?

Here are a lengthy lists (terms are often very technical if not explained)

1. Angina Pectoris/Myocardial Infarction - simply put is heart attack

2. Other Cardiovascular Causes

a. Possibly Ischemic Pain

1) Aortic Stenosis - the biggest artery of the heart is not opening well to let go off its content
2) Hypertrophic Cardiomyopathy - the unusual enlargement of the muscles of the heart living behind a rather small hollow concavity inside the heart.
3) Severe Systemic Hypertension - severe high blood pressure
4) Severe Right Ventricular Hypertension - another type of high blood pressure
5) Aortic Regurgitation - again dealing with the largest artery of the heart not properly ejecting its content out
6) Severe Anemia/hypoxia - deficiency of oxygen supply in the body

b. Non Ischemic in Origin

1) Aortic Dissection
2) Pericarditis
3) Mitral Valve Prolapse

3. Gastrointestinal

a. Esophageal Spasm
b. Esophageal Reflux
c. Esophageal Rupture
d. Peptic Ulcer Disease

4. Psychogenic

a. Anxiety
b. Depression
c. Cardiac Psychosis
d. Self Gain

5. Neuromusculoskeletal

a. Thoracic Outlet syndrome
b. Lesions of Cervical/Thoracic Spine
c. Costochondritis[Tietze�s Syndrome]
d. Herpes Zoster
e. Chest wall pain

6. Pulmonary

a. Pulmonary Embolus/Infarction
b. Pneumothorax
c. Pneumonia with pleural involvement

7. Pleurisy

(this is updated list of differential diagnosis is lifted from the article of Dr. Apurva C Madia. Consultant Cardiologist. Ahmedabad, India.)

What then is the simple daily dose of remedy for Chest Pain? Pain tolerance is individualized. What could be painful to me, may not be painful to another. So, the mainstay of remedy for this is to free the patient off the pain. After which we should advise and educate the patient about the different causes of the chest pain. It is best to always ask your doctor ,if a total cardiologic laboratory work-up is necessary. Is is also pertient to ask if the pain is most likely caused by an organ (heart) or an organ other than the heart, i.e. muscle, tendons or simply by stress.

To put this all astride, my sisters symptoms were all due to mixed up stress and muscle and tendon inflammation. She is all well now thanks to a very good and effective pain reliever.