Q: My 60 years old father weighs 95 kg. He underwent a coronary angiogram where it was found that there were no blockages. However, he continues to experience pain around his chest area and the consulting doctor told that it could be due to muscle pain or so. What causes chest pain?

A:Chest pain could occur because of multiple causes and only a small percentage of them arise from the heart. However, because heart pain is the most serious one, the dictum is that every chest pain should be treated as coming from the heart, unless and until proved otherwise, but in generic terms majority of chest pains do not come from the heart and may arise either from the muscles or bones & joints of the chest wall or from the food pipe and the stomach. Even underlying lung and its covering layers can give rise to chest pain. So to pin point the cause of pain through remote consultation internet would be impossible. Normal coronary arteries on angiogram rules out blockage in the major arteries of the heart. However, some times smaller arteries, which are microscopic and not visible to the naked eye and therefore not seen on the angiogram, may have blockages. Also the inner lining of these blood vessels may be at fault (endothelial dysfunction) and can some time lead to sluggish circulation in the micro circulation of the heart and produce chest pain (called Syndrome X). However, for all this, you need to consult a cardiologist who only can give you a firm answer as to the cause of the chest pain and the further treatment that you need to take. This is decided also keeping in mind the risk profile of the individual in form of, does he have diabetes, hypertension, family history, history of tobacco intake etc. So I suggest that you consult your cardiologist on this matter. As an after thought, I notice that the weight reported is 95 kgs, which is significant obesity and he should make an effort to reduce his weight also, which may help matters tremendously.