Many people are worried about pain on the left side of the chest. For doctors too chest pain sometimes poses a diagnostic dilemma. This is compounded by the fact that all heart attacks do not necessarily herald their arrival with chest pain. In up

to 45 per cent of people, a first heart attack may be painless. Symptoms of a silent heart attack may be mistaken for chest strain or indigestion. A painless attack is commoner in women.

Heart attacks are caused by the complete or partial blockage of blood flow in one of the vessels supplying the heart. The risk of this increases with age, obesity, diabetes, high lipids, smoking, a family history of heart disease and lack of exercise. It is often picked up incidentally during a routine check-up.

A painless heart attack needs to be taken seriously, and the patient evaluated. Any lifestyle diseases and contributing habits need to be corrected. This way a second massive attack, which may even be fatal, can be prevented.

A heart attack may occur suddenly. In most people, however, there are recurrent warning symptoms of intermittent pain and tightness in the chest. These may be triggered with activity and disappear with rest. It means that the block in the heart’s blood vessels is still partial.

A typical heart attack can cause chest pain, anxiety, palpitations and difficulty breathing. The pain may radiate down the left arm or up into the neck. The pain may feel like heartburn and remain localised in the abdomen. It can be accompanied by nausea and vomiting, confusing the clinical picture further. In women, particularly, there may just be mild chest or abdominal pain and unexplained long-lasting fatigue.

An ECG taken during a suspected heart attack shows typical changes. It can be followed up with a chest X-ray, an echocardiogram, a cardiac MRI and an angiogram. (Sometimes, it may be possible to “stent” the block via angioplasty). Blood tests such as tropin, CK (creatine kinase) or Ck-MB (creatine kinase myocardial band) can also be used.

Emergency first aid for a suspected heart attack is to make the person lie down, loosen any clothing and ask them to chew on an aspirin. Chewed aspirin works faster than swallowed pills. Take them to the hospital as soon as possible.

A heart attack occurs when part of the heart muscle dies as a result of reduced blood supply. Chest pain resembling a heart attack can occur because of other cardiac problems. One of these is myocarditis, an inflammation of the heart muscle, which is usually viral. The covering of the heart may become infected (pericarditis). This causes intermittent sharp, shooting, stabbing pains.

Other conditions are hypertrophic cardiomyopathy and mitral valve prolapse. These are long standing chronic conditions that may have been diagnosed earlier.

Infections of the lung —such as pneu-monia or abscess — and of the lining of the lung (pleura) can mimic a heart attack, especially if the problem is on the left side. Herpes zoster can cause severe pain along the chest a few days before the typical blisters appear.

The oesophagus can be sensitive, develop ulcers or diverticula or have unco-ordinated propulsion of food. The pain can be very severe. Peptic ulcer and hiatus hernia can also mimic a heart attack.

Once you have reached the age of 45, it is important to have a health check-up every year to evaluate the blood sugars, lipid profile, ECG and liver and kidney function values. Diabetes, hypertension and high lipids should be treated immediately. Obesity should be controlled.

Walking for 40 minutes a day is the most effective (and cheapest) way to maintain your heart health.