Both young and old, have intermittent chest pain. Chest pain can be alarming, as it might indicate severe heart disease or even a heart attack. However many people (and most young people) have chest pain that is not caused by the heart – this is called non-cardiac chest pain. The most common cause of non-cardiac chest pain arises from a nearby organ, the esophagus (food pipe). Esophageal causes of non-cardiac chest pain include gastroesophageal reflux disease (GERD) and gastroesophageal spasm. GERD results from stomach acid backing up into the esophagus, which produces heartburn and chest pain. Esophageal spasm is caused by chaotic muscle contractions of the lower esophagus aggravated by acid reflux, stress, or unknown factors. Another common cause of non-cardiac chest pain is musculoskeletal problems, especially fibromyositis (muscle inflammation). Finally, anxiety and panic attacks can produce chest pain that resembles the pain experienced during a heart attack. The chest pain is usually in the middle of the chest and is characterized by a dull, burning, or pressure sensation. The pain usually does not radiate into the neck, shoulders, or arms. Non-Cardiac chest pain secondary to esophageal causes is made worse during or after meals, when lying on the back (supine position), exercising, or when experiencing anxiety. Associated symptoms are often found including heartburn, acid regurgitation or difficulty swallowing, and a feeling of food sticking in the middle of the chest (dysphagia). Non-Cardiac chest pain secondary to musculoskeletal disorders can be located anywhere on the chest wall (multiple painful sites are common). Patients may also complain of muscle and joint aches, fatigue, and difficulty sleeping. The chest pain associated with anxiety and panic attacks is accompanied by a feeling of impending doom, shortness of breath, heart palpitations, sweating, and insomnia. Most patients can have complete relief of their symptoms if the appropriate cause of non-cardiac chest pain is identified.

Some Non-Cardiac Causes for Chest Pain

Gastrointestinal Causes – the Digestive Tract: Usually burring in nature, this pain gets relieved with antacids like digene. Pains originating from the digestive tract often can mimic heart pains.

Musculoskeletal Causes: Typically sharp and confined to a specific area of the chest. They may be brought on by the movement of the chest and/or arms into certain positions, and often are relieved by changing position.

Causes in the Lungs: The pain of pneumonia and pleuritis are often made worse by deep breaths or coughing. The pain of pneumothorax may be felt more acutely with deep breaths or may be made better or worse by assuming certain positions. Like

Aortic Dissection: Often described by survivors as the worst pain they ever experienced, the pain of aortic dissection may last hours, even days.

Nerve Impingement – Cervical Spondylosis: Cervical Spondylosis is the disease of the bones of the neck. A disease commonly associated with aging, it results in a lack of flexibility of these bones and flexibility of these bones and narrowing of the spaces which are present in between two spaces.

Shingles – Herpes: Because of the onset of discomfort or pain associated with shingles can precede the appearance of vesicles by several days, a person can experience pain in a certain area of the chest for several days before the cause becomes apparent.

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Stable angina is pain, pressure, or a sense of heaviness in the chest beneath the breastbone. It is brought on by physical exertion and is relieved by rest. The discomfort or pain may also be felt in the left arm or shoulder, the neck, or the lower jaw. These are all areas of the body supplied by the same nerve that goes to the heart.

What is going on in the body?

Atherosclerosis, or hardening of the arteries, is a condition in which fatty deposits, also called plaque, form inside blood vessel walls. Atherosclerosis that involves the arteries supplying the heart is called coronary artery disease. Plaque that blocks the flow of blood through the arteries. The tissues that normally receive blood from these arteries supplying then begin to suffer damage from a lack of oxygen. When the heart does not have enough oxygen, it responds by causing the pain or discomfort known as angina.

What are the signs and symptoms of the conditions?

Symptoms of angina include:

·       Chest pain or discomfort that is brought on by exertion but goes away with rest.

·       Palpitations or an unusual awareness of the heart beating in the chest.

·       Shortness of breath.

How is the condition diagnosed?

Angina is usually diagnosed by a history of chest discomfort that is caused by exertion but goes away with rest. A physical exam may reveal signs of hardening of the arteries. An electrocardiogram or ECG is the recording of the heart’s electrical activity. An ECG is usually normal when a person has no pain, and it shows certain changes when pain develops. An ECG done during exercise will show similar changes even before angina develops. This is known as the TMT or the treadmill test.

A cardiac catheterization, or coronary angiogram, is a procedure that is used to look for narrowed coronary arteries. A contrast agent is injected into an artery and X-rays are then taken. This procedure can be used to find narrowed blood vessels supplying the heart. But this procedure is an invasive test and the blockages are estimated by visual interpretation only. This is why they are defined as 70%, 80%, 90%, and 99%, and so on. The estimations can vary from expert to expert whereas they could be 72% or 82.56% also.  Moreover, this procedure is done only to prepare the patient for revascularization surgeries like ballooning or bypass which is only a temporary process to relieve angina. Hence this test is generally advised by SAAOL which aims at the reversal of heart disease only.

Other Cardiac Causes for Chest Pain

1.    Myocarditis:  It is an inflammation of the heart muscle from any cause. Inflammation can change the heart in many ways. It can make it weaker and affect the way it functions. Inflammation can cause certain areas of the heart muscle to die. Sometimes only a small area is affected, but serious cases may involve the entire heart. Symptom wise, besides chest discomfort it may cause fatigue or weakness.

2.    Constrictive Pericarditis: The sac of fibrous tissues that surrounds the heart is called the pericardium. Constrictive Pericarditis results from scarring of this lining. The scar encases the heart and may limit its ability to pump blood. The pericardium is a thin sac that covers the heart. As it heals from an infection or injury, a scar may form. The pericardium becomes rigid due to the scarring. This may restrict the filling of the heart with blood and cause other health problems. 

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Complaints of pain localized to the chest pose a diagnostic challenge. Many individuals with chest pain have a benign course due to a self-limiting musculoskeletal process. However, appropriate and dedicated attention must be paid to each individual to approach the most likely clinical etiology.

Although chest pain is always a symptom of an underlying condition, the condition may not be a heart-related illness. The underlying condition may be serious (e.g. coronary artery disease), but many times it is not (e.g. heartburn). To be sure about proper treatment, anyone experiencing chest pain is encouraged to see a physician.

Chest pain is a broad term used to describe a variety of symptoms, including tightness, squeezing, crushing, choking, and radiating pain or numbness of the chest area. While chest pain does not always mean a heart attack, people should call emergency if they are experiencing:

· Chest pain or discomfort that is unrelieved by rest or a change in position and often spreads or radiates through the upper body to the arms, neck, shoulders, or jaw.

· Chest area pressure or squeezing sensation that may be either constant or intermittent.

What to do in case of Chest Pain?

Step 1: Take rest.

Step 2: Sorbitrate 5 mg. below the tongue.

Step 3: Repeat step 2.

Step 4: Report to the doctor.

Especially for a heart patient.

This is a simple set of rules to be followed in case you experience chest pain. In step no. 1 as soon as you experience the pain, please stop whatever activities you are doing and take rest. In the case of angina, the pain will go away with rest.

Step no. 2 is to be resorted to when step no. 1 fails. If this step also fails to relieve the chest pain then you can repeat it again in step no. 3 after waiting for 2-3 minutes.

Suppose after three steps the chest pain persists then you have to visit the doctors, who will immediately do an ECG. There is only possibilities, either cardiac or non-cardiac pain. ECG will show changes in case of cardiac pain whereas in case of non-cardiac pain it will be normal.

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Chest pain refers to pressure, squeezing, or general discomfort in the chest area, which includes the heart, breast, and neck areas. Any pressure or pain in the chest area is collectively referred to as chest pain. Chest pain varies in location, duration, frequency, and strength, depending largely on its cause. The pain may be temporary or prolonged. It may occur sporadically, frequently, only during certain times (like during exercise) or only once.

Alternative names: chest tightness or pressure, chest discomfort, or breathlessness in case of diabetics who may not experience any pain.

Like many people with chest pain, you may fear a heart attack. However, there are many possible causes of chest pain. Some causes are mildly inconvenient, while other causes are serious, even life-threatening. Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves.

If your chest pain is new or different from previous episodes of chest pain, you should be evaluated by a healthcare provider right away. This is especially true if you have any symptoms suggestive of a heart attack.

Chest pain is not a condition; it is a symptom of either serious illness (e.g. coronary artery disease or a heart attack) or a medically insignificant cause (e.g. heartburn). Chest pain that is caused by a change in position or a deep breath may relate to another heart condition, such as pericarditis or a lung condition such as a blood clot. In contrast, chest pain associated with a cold drink is usually not heart-related.

The chest is the area where the heart and lungs are located. These organs are protected by the rib cage and breastbone. Many different conditions can cause pain in the chest. Some causes of chest pain require prompt medical attention, such as angina, heart attack, or tearing of the aorta. Other causes of chest pain can be evaluated electively, such as spasm of the esophagus, gallbladder attack, or inflammation of the chest wall. Therefore, an accurate diagnosis is important in providing proper treatment to patients with chest pain. In adults, it is often a cause for concern because it can signal a heart attack. However, many conditions ranging from a pulled muscle to pneumonia can cause chest pain.

Medical attention should always be sought in instances of chest related pain or symptoms such as the following:

·       Tightness

·       Squeezing

·       Crushing

·       Choking

·       Radiating pain

·       Numbness

·       Additional feelings (angina equivalents) such as dizziness, shortness of breath, sweating, faintness or fatigue

·       Any new chest discomfort, especially in patients over the age of 40.

Breathlessness could be another mode of presentation which can point towards a cardiac/non-cardiac reason. But in case of cardiac problems like angina, the shortness of breath will be exertional. Breathlessness due to any lung pathology will always be associated with symptoms related to the underlying illness like fever, cough, etc. Heart patients who complain of breathlessness are usually diabetics who have deranged nerve conductions resulting in a lack of pain.    

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The key to healthy eating is the advice of balance, variety, and moderation in diet. In short, that means eating a wide variety of foods without getting too many calories or too much fat. These 10 tips can help you follow that advice while still enjoying the foods you eat.

Tip 1. Adopt Saaol’s Zero-Oil Cooking:-

The most advanced and effective way to cut visible fat from our diet and the best part of this cooking style is, it just cut down the calorie neither your taste’ nor your nutrients. It gives you variety also you can prepare 100’s of different dishes with this cooking style.

Tip 2. Adopt Vegetarianism:- 

No doubt, non-vegetarian foods are rich in nutrients- a very good source of protein, iron but fat also and that is cholesterol- the main culprit of heart disease. Along with this non-vegetarian meal, cooking in any form will always serve you a very dense source of calories. Indigestion that will further lead stress on all organs and will easily deposit around them.

Tip 3. Eat a variety of nutrient-rich foods:- 

You need more than 40 different nutrients for good health, and no single food supplies them all. Your daily food selection should include bread and other whole-grain products; fruits; vegetables and dairy products. How much you should eat depends on your calorie needs.

Tip 4. Enjoy plenty of whole grains, fruits, and vegetables:-

Surveys show most people don’t eat enough of these foods. Just take a look at your daily diet plan and found how many times in a day you consume them.

Tip 5. Keep an eye on quality:- 

Eat-in moderation will keep you light and will help your digestive system to work properly.

Tip 6. Eat regular meals:- 

Skipping meals can lead to out-of-control hunger, often resulting in overeating. When you’re very hungry, it’s also tempting to forget about good nutrition. Snacking between meals can help curb hunger, but don’t eat so much that your snack becomes an entire meal.

Tip 7. Keep on reducing:- 

Most people eat for pleasure as well as nutrition. If your favorite foods are high in fat, salt, or sugar, the key is moderating how much of these foods you eat and how often you eat them, keeps it gradually reducing till the elimination.

Tip 8. Balance your food choices over time:- 

Not every food has to be “perfect.” When eating a food high in calories, salt, or sugar, select other foods that are low in these ingredients. If you miss out on any food group one day, make up for it the next. Your food choices over several days should fit together into a healthy pattern.

Tip 9. Know your diet pitfalls:-

To improve your eating habits, you first have to know what’s wrong with them. Write down everything you eat for three days. Then check your list according to the rest of these tips.

Tip 10. Make changes gradually:-

Just as there are no “superfoods” or easy answers to a healthy diet, don’t expect to totally revamp your eating habits overnight. Changing too much, too fast can get in the way of success. Begin to remedy excesses or deficiencies with modest changes that can add up to positive, lifelong eating habits. For instance, if you don’t like the taste of skim milk, try low fat. Eventually, you may find you like skim, too.

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Preventive cardiology, till now has described the risk factors of coronary heart disease with a range. The range included the highest to the lowest limits of the particular risk factors. As it is convenient, most of the patients tried to maintain themselves at the highest of the level. For example, the highest range of serum cholesterol is 130 mg/dl to 200 mg/dl. Most of the doctors and patients who have about 200 mg/dl are very happy and consider themselves completely safe. SAAOL recommends 130mg/dl. The idea is to look for the best of the possibilities.

The second problem or preventive cardiology is the absence of improvement. Even after following instructions, people still would get heart attacks that would break their determination to follow the advice after some time. Mild to moderate changes were not enough to make them compliant in the long run.

Aggressive prevention aims at reversal and not just slow or no progress. Now it is a proven and accepted fact that the blockages can be reversed. Even if the blockage goes down by 1-2%, there is a tremendous symptomatic improvement and the patients are completely protected from a heart attack.

The third fault of preventive cardiology is the lack of importance given to stress and its management. Though stress is today considered the major reason for heart disease, because of its non-measurement of (in terms of clearly defined units like kilograms, milligrams, or milliliters) medical science so far has not given proper importance to this most important parameter. Stress management, against has not been included as a part in the control of heart disease. This needs to be done immediately.

The fourth and the main fault of preventive cardiology is the absence of practical instructions and guidelines for the patients. Most of the instructions were ambiguous. When we know that oils are triglycerides or fats and are the apparent causes of arterial blockages then they should be clearly forbidden. We should also teach the patients how to cook without oil and yet make it tasty. In the absence of a viable alternative, the instructions become redundant. Thus, the need is not only clear instructions but also the evolution of a complete package, which can be followed by the community in a practical way. This should not be confined to one or two risk factors but should include all the possible risk factors of heart disease.

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What are Lipoproteins? (Good and Bad Cholesterol)

Cholesterol and other fats cannot dissolve in the blood. They have to be transported to and from the special carriers called a lipoprotein. There are two kinds of lipoproteins that you need to be concerned with. Low-Density Lipoprotein or “LDL” is also known as bad cholesterol. Too much LDL can clog the arteries to your heart and increase your risk of a heart attack. High-Density Lipoprotein, or “HDL”, is also known as the “good” cholesterol.

Can Any Cholesterol Be Good For The Heart?

Certain cholesterol facts are well known. There is a general consensus that High-Density Lipoprotein (HDL) is “good cholesterol”. It transports free cholesterol from blood to the liver where it is esterified by Lecithin Cholesterol Acyl Transferase (LCAT).  The apo-1 component of HDL promotes activation of LCAT and removal of free cholesterol to be deposited inside the walls of blood vessels.

HDL interacts with peripheral cells of tissues by binding of cells surface receptors via one of the HDL apoproteins A-1 and its less dense fraction contains a relatively higher concentration of apo A-1 and hence it prevents deposition in the walls of blood vessels. HDL opposes the EDRF-inhibitory effect of LDL and free cholesterol, promotes the release of prostacyclin from endothelial cells, and stabilizes circulating prostacyclin. Prostacyclin inhibits mitogen release of platelet-derived growth factor by its effects on cholesterol metabolism.

HDL indirectly has better antioxidant properties leading to antideposition effect. These functions make HDL cholesterol good cholesterol. 1-2 mg/100 ml increase in HDL is associated with a 2-4% reduction in Coronary Heart Disease (CHD) risk. Low values act as a risk factor irrespective of total cholesterol.

Several studies have been carried out to show that deficiency of HDL is a risk factor for CHD. One study in the west names PROCAM trial showed that HDL under 35mg/100 ml showed a 65% risk of CHD whereas over 35mg/100 ml the risk was 36%. Multiple Factor Intervention Trial (MRFIT) and Lipid Research Clinics Coronary Primary Prevention Trial (LRCPT) showed that HDL of more than 45mg/100 ml as a proactive role.

Helsinki heart study showed that 11% increase in HDL caused a 34% decrease in CHD.  In Indian studies, Rajeev Gupta in Rajasthan showed that 23.9% of men had less than 35mg/100 ml and Reddy’s study in Delhi at AIIMS showed that 59.9% had less than 40mg/100 ml.

In India, the levels of HDL are low as compared to the West.

It is important to raise HDL cholesterol. This is possible by physical exercise, high fiber vegetarian diet, fruits, green vegetables, correction of obesity, and stopping excess alcohol consumption, smoking and tobacco products.

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Saaol includes the use of Allopathic medicines in its treatment. These medicines have an advantage that they can work instantly to reduce Angina (pain, heaviness, breathlessness on exertion). They can reduce blood pressure, sugar with immediate effect. We need to get the patients back to normal life as soon as possible – so we prescribe those medicines but the patients are instructed to adopt a lifestyle that will help them to prevent and reverse the disease. As the results come we try to reduce the medicines – and all our successful patients gradually find their medicines being withdrawn. Some medicines have to be continued for a long time.

Heart medicines can be roughly categorized into the following groups. All the cardiologists in the whole of the world have to prescribe the following – only the trade names keep on changing. All these medicines work for 8 hours or 12 hours or 24 hours depending on the time Kidney takes to throw it out of the body. Thus they have to be taken thrice a day, twice a day, or once in a day. So, they must be repeated every day. None of these drugs cure heart disease. So, they are prescribed for years.

1. Dilators/Anti Anginals


3.Beta Blockers

4.Calcium Channel Blockers

5.ACE Inhibitors

6.Cholesterol Lowering drugs

7. Triglycerides lowering drugs

8.Drugs used for a low pumping power of the heart.

Dilators/Anti Anginals

Sorbitrate is the most popular medicine in this group. The action is to increase the blood supply of the heart muscles and relieve chest pain/Angina. Most of them make the tubes wider and are broadly categorized as Dilators. As soon as they reach the blood the action starts. Sorbitrate, when taken below the tongue, reaches the blood in less than 1 minute. Other medicines are taken orally and take about 30 minutes to one hour for action.

Four groups of these drugs are popular: Nitrates, Trimetazines, Nikorandil and Ranolazine. Saaol has medicines for all these four categories. A new drug called Ivabradine is now also used to reduce Angina.

Blood thinners

Most of the popularity of this group is Ecosprin or Disprin. They make the blood thinner/less viscous and prevent it from clotting. They may help in preventing clot formation and heart attacks – but not definitely. But this is the most widely prescribed drug for heart patients. Aspirin (the inner compound of Ecosprin or Disprin) is not good for patients with a tendency to the acid formation or gastric ulcers – so, a new group called Clopidogrel has become popular. In advanced patients, both the thinners are often prescribed. Saaol has both the thinners.

Drugs that reduce the Oxygen requirement of the heart

Three major groups fall in this category and most of them are also used for Blood pressure reduction. These are – Beta-blockers, Calcium Channel Blockers, and ACE Inhibitors. They actually help to reduce angina by reducing the oxygen requirement of the heart and lowering the high blood pressure. Saaol has medicines from each of these groups.

Cholesterol and Triglyceride Reducing drugs

As you know the blockages that cause the heart disease are basically made from Cholesterol and Triglycerides. These two, if not controlled, has the highest capacity to create heart attacks. The cholesterol-lowering drug – Atorvastatin- is one of the highest-selling drugs in the world. Saaol produces this drug by the name – Atosol. For triglycerides, Saaol’s drug is Fenofibrate – called Fenofisol. A combination drug – Chol TG Sol is also being manufactured by Saaol.

Drugs which are used for low pumping power of the heart 

Though not prescribed for general heart patients – these drugs also are very vital to survive heart patients after severe heart attacks. Some of them are for throwing water out of the body called Diuretics ( like Lasix, Dytor, Tide, Lasilactone, Amifru), some strengthen the heart (Cardivas, Vymada, Eptus, Carvidilol, ) and some help to increase the pumping power of the heart (Digoxin, Lanoxin). Saaol is not manufacturing these medicines for the time being.

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Saaol Pharma

Dr. Bimal Chhajer, the founder of the Saaol revolution, had been thinking of ways and means of reducing the cost of the daily intake of medicines for a long time. We published many Saaol Times magazines in the past years comparing the cost of different brands of medicines and suggested to our readers/patients brands that were less costly in every group. Many of them shifted to low-cost medicines. But many of these low-cost medicines were not widely available. When Dr. Chhajer prescribed these medicines the patients had a bad time to search for them in hundreds of Chemists. 

On the occasion of the 25th Anniversary of SAAOL, we decided to start our Social Endeavor – Saaol Pharma with a slogan “High-Quality Medicines at a low cost”. Saaol started in September 1995 when Dr.Chhajer resigned from the famous AIIMS, New Delhi. In September 2020 Saaol will complete 25 years of service for the heart patients. And all kinds of heart-related medicines are available at our all centers.

These medicines are very high quality and we spent more than one lac rupees to obtain quality certificates for each of these medicines from the Government recommended testing laboratories. These certificates have been put on the website of Saaol Pharma and can be examined by anyone. In the future for every batch of medicines, we plan to maintain the same procedure.    

Why we could keep the cost so low?

Saaol medicines are 40%-60% lower in cost when compared with the medicines from India’s topmost Drug companies and popular brands.  The reasons behind this low cost (without compromise on the quality) are as follows:

1. We have no overheads. No marketing team, no medical representatives. No need to convince the doctors to write our medicines

2. We shall be able to sell the medicines from our own centers. No C&F (carrying and Forwarding agents), no distributors, or medical shops/retailers. The elimination of middleman reduced our cost.

3. We do not need to do any advertisements, no printing of brochures, pamphlets

4. We do not need to sponsor conferences; no gifts are needed for the prescribing doctors.

5. We have limited products – mainly heart medicines. So we do not need many staff – junior managers, senior managers and all. This also keeps the cost low. 

How to buy Saaol Medicines?

1. You can buy directly these medicines from our center by paying cash.

2. You can buy online/through the internet by scanning your prescription and sending it to Saaol Pharma. The payment can be done online.

3. You can deposit Rs. 5000 or maximum Rs.10000 to the account of Saaol Pharma by cash or cheque as advance money and the get medicines delivered at your home by courier. For any supply worth more than Rs. 3000 – there will be no courier charges.

4. If you have bought excess medicines and want to refund them it is definitely possible.  It can be done at any Saaol center. 

How to Shift to Saaol Medicines?

To a shift to Saaol medicines – all you need to do is to report to your nearest Saaol center, show your old prescription and change to Saaol medicines. Our doctors will guide you to change the brand name and make a new prescription for you. Immediately your cost of monthly medicines will start reducing. You can use our helpline no.011-42401717 or Dr. Pawan’s number 98999 70428 to get any assistance from Delhi. You can introduce your friends and family members to Saaol medicines as well.

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Temporary/Non-Serious Causes:

1. Strenuous Exercise
2. Inadequate sleep
3. Excess Alcohol
4. Too much of tea, coffee
5. Stress and Anxiety
6. Dehydration,
7. Fever
8. Low Blood Sugar
9. Anemia
10. Drug Abuse
11. Uncontrolled Diabetes or high BP
12. Hyper Thyroid – overactive Thyroids
13. Few medicines: Asthma medicines (Salbutamol, Deiphylline), BP medicines (Hydralazine, minoxidil), Some antihistamines (Terfenadine), Antidepressants (Citalopram, escitalopram)

Other more serious causes:

1.     Blockages in heart arteries – Ischemia
2.     Heart attacks or cardiac arrest
3.     Injured heart areas due to previous Heart attack
4.     Valve diseases: congenital or acquired
5.     Cardiomyopathy
6.     Heart failure – acute or Chronic
7.     Previous heart surgery or complicated Angioplasty

Identification of Arrhythmia

Palpitation, Breathlessness, Chest Pain, Dizziness, Fainting (Syncope), Tiredness, Uneasiness, Light Headedness.

Risk factors

Certain conditions may increase your risk of developing an arrhythmia. These include:

·Coronary artery disease, other heart problems, and previous heart surgery
·High blood pressure
·Congenital heart disease
·Thyroid problems
·Obstructive sleep apnea
·Electrolyte imbalance


Certain arrhythmias may increase your risk of developing conditions such as:

· Stroke or Paralysis
· Heart failure
· Sudden Cardiac Arrest
· Worsening Arrhythmia

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