Chest pain and breathlessness are among the most concerning cardiovascular symptoms patients experience. According to Dr Rajdatt Deore, Consultant Cardiologist, Manipal Hospitals, Baner, Pune, while many
individuals may attribute these symptoms to anxiety, gas, or fatigue, a significant number are actually dealing with underlying coronary artery disease.
“Determining whether chest pain or breathlessness signals a serious blockage in the coronary arteries and deciding when further evaluation through coronary angiography is required—can be clinically challenging,” explains Dr. Deore.
Chest discomfort may present as pressure, tightness, or a burning sensation and can radiate to the left arm, neck, back, or jaw. “In many patients especially women, elderly individuals, and those with diabetes, breathlessness may be the most prominent symptom, sometimes even occurring in the absence of chest pain,” notes Dr. Deore. This symptom can arise at rest or during physical activity and is often overlooked, leading to delayed diagnosis. The atypical presentation of breathlessness, combined with its association with potential coronary blockages, frequently results in missed or late identification of heart disease.
Initial evaluation typically includes an ECG, blood tests, and non-invasive cardiac imaging such as echocardiography or stress testing. “These tests are valuable screening tools,” says Dr. Deore, “but they cannot accurately determine the exact location or severity of arterial blockages.” When symptoms persist, worsen, or are accompanied by reduced heart function, coronary angiography becomes essential.
During coronary angiography, contrast dye is injected into the coronary arteries, allowing real-time imaging of blood flow. “Angiography remains the gold standard for detecting significant narrowing or complete blockages in the coronary arteries,” emphasises Dr. Deore. He recommends the test for patients with ongoing chest pain, exertional breathlessness, abnormal stress test findings, reduced pumping capacity of the heart, or suspicion of acute coronary syndrome.
One of the major advantages of timely angiography, according to Dr. Deore, is the ability to move swiftly from diagnosis to treatment. “If a major blockage is identified, angioplasty and stenting can often be performed immediately to restore blood flow,” he explains. Many patients experience rapid symptom relief, reduced risk of further heart muscle damage, and faster recovery when intervention follows promptly.
In cases where angiography reveals multiple severe blockages, left main coronary artery disease, or complex coronary anatomy, coronary artery bypass graft surgery (CABG) may be advised. “When performed on appropriately selected patients, CABG offers durable, long-term outcomes by creating alternate pathways for blood flow,” says Dr. Deore.
Delaying angiography when clinically indicated can have serious consequences. “Postponing this investigation may lead to irreversible heart damage, heart failure, or even life-threatening events,” warns Dr. Deore. Conversely, early diagnosis allows heart disease to be treated before complications arise.
“Chest pain and breathlessness should never be ignored,” concludes Dr. Rajdatt Deore. “When there is a possibility of coronary artery disease, angiography provides the clarity needed to take timely, life-saving action.”
