Leisure, Lifestyle & Wellness
Every chest pain doesnt mean a heart attack
There are multiple causes of chest pain, like muscular aches and pains,  pain related to pneumonia, chest injury etc. All have their own pathognomonic signs and symptoms
With today’s information explosion, people have become mortally afraid of an impending heart attack because of over-hyped risk factors and unnecessary advice. Doctors have added to this mess too and, in this situation, it is probably difficult for patients to remain calm and not get worried about a heart attack. As a result, cardiac neurosis is on the rise. 
Although cardiac neurosis was a rare disease when I was a student in the 1950s, today, I see one or two such patients almost daily. It is much easier to treat real myocardial ischaemic pain than imaginary ‘heart pain’ in the chest. Years ago, a Canadian study had shown that in the period that a doctor  sees one heart attack, he or she will have seen more than 36,000 minor illness syndromes.
In my experience, the best diagnosis of a cardiac origin for chest pain depends on good history taking and bedside evaluation, even with all the scanners, echoes and angiograms. 
Coronary angiograms are not the gold standard for the diagnosis of coronary artery disease as majority of healthy adults and even some children have multiple blocks in the coronary vessels that get compensated by innumerable collaterals stimulated by the slow atherosclerotic intraluminal blocks, which pre-condition the myocardium for any sudden future blockage of the coronaries by a blood clot.
A doctor’s responsibility towards making an accurate diagnosis of coronary artery disease becomes much more important in view of the cardiac neurotics ending up on the catheter laboratory table for angiograms. Some of these unfortunate victims might even end up with surgical coronary bypass grafts! 
The chest pain due to coronary artery disease does not follow a typical pattern, although there are some telltale signs of it in the nature of the pain. Usually, significant coronary artery disease produces chest pain because of the momentary defects in the contraction of the muscle wall, called wall motion abnormality. 
Heart muscle, as such, has no pain fibres that can give rise to pain. But the pericardium, the outer cover of the heart, is flooded with pain fibres, especially at its apex. When there is significant loss of blood supply to a portion of the heart muscle, there is a corresponding wall motion abnormality which produces shear-stress on the pericardial sac, resulting in pain. This pain can manifest anywhere between the neck and the abdomen and can range from a minor niggle to a severe unbearable pain, at times, spreading to the left shoulder, left hand, the throat and even the lower jaw. 
However, the pain, in all these locations, is usually secondary to the central chest pain. The sine-qua-non of ischaemic chest pain is the accompanying feeling of tightness in the chest, leading, in severe cases, to shortness of breath. An intelligent doctor who develops the capacity to listen to his/her patients can make an accurate diagnosis in his office or on the bedside. The usual neurotic, with non-cardiac chest pain, could be diagnosed with history alone. Many a time, the pain lasts all day, which is very unlikely in cardiac pain, as any angina pain lasting more than half an hour results in a heart attack.
From the patient’s point of view, the best doctor to consult in case of chest pain is the family physician who knows the patient’s background to make an accurate diagnosis. 
The specialist seeing the patient for the first time might over-diagnose cardiac pain and take up the patient for further investigation right away, not to speak of the usual disease-mongering effort in these times of hi-tech competitive medical practice. Such doctors justify their actions by saying, they did not want to miss any coronary artery disease; this is called defensive medicine in the USA.
Some intelligent neurotics might even complain of shortness of breath with their chest pain. This might mislead an anxious doctor, afraid of missing a heart attack. If one carefully analyses the shortness of breath, one quickly realises that they are just ‘sighs’ and not true breathlessness. The telltale sign of coronary-related shortness of breath is the inability of the patient to hold his breath.
There are multiple causes of chest pain, like muscular aches and pains,  pain related to pneumonia, chest injury etc. All have their own pathognomonic signs and symptoms. In conclusion, doctors must be acutely aware of cardiac neurosis as a significant cause of chest pain.
Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.




2 years ago

Dr Dr Hegde
I have been introduced to your writing by money life some years back.
I have become a big fan of yours as you have busted many myths and malpractices.Your ideas on vaccines excessive medicine usage were an eyeopener.
Please keep up your good work

Moneylife Foundation calls for a round-table discussion on ATMs usage and charges

Moneylife Foundation, as the voice of over 30,100 savers, has sent a memorandum to the RBI and also called for a round-table discussion on 13th September with like minded citizens, activists and NGOs to take up ATM usage and charges issue with the banking regulator


The Reserve Bank of India, on 14th August issued a very anti-consumer directive restricting free usage of automatic teller machines (ATMs) by customers. This is in contrast to its own 5-point consumer charter (CC) that was well appreciated by media and bank customers.


Moneylife Foundation, along with several like minded citizens, activists and non-governmental organisations (NGOs), is protesting RBI's move restricting free usage of ATMs by bank customers.


Moneylife Foundation also sent a memorandum to RBI governor Dr Raghuram Rajan, requesting him to restore unlimited usage of ATMs by banks to their own customers, restore differential pricing for cash and non-cash transactions at ATMs and introduce a system of reporting out of order ATMs for customers.

In addition, Monelife Foundation has called for a round-table discussion on this issue at Moneylife Foundation Knowledge Centre at Dadar in Mumbai on 13 September 2014 between 2.30pm to 4.30pm. All citizens, activists and NGOs who wish to be part of this discussion and take this forward are invited to join the round-table. There is also a need to write to the RBI that any directive that leads to increased costs to the depositor must be discussed with bank customers, the largest stakeholders.

Currently, banks have the freedom to decide their charges and interest rates without reference to RBI. So, if some banks found it prudent to curb usage or disallow third-party transactions, they could have gone ahead and done it without RBI’s intervention. So why the RBI directive? To make an anti-consumer action look like a regulatory diktat?

The Indian Bank's Association (IBA) used its influence on the central bank to ensure that angry customers do not vote with their feet and switch banks. Getting RBI to issue a directive removes the problem.

It also ignores the fact that IBA behaves like a cartel under RBI’s benign watch. That is how all banks act together to charge for mobile texts and debit cards and ensure that interest on savings bank deposits remains a low 4% at all but a couple of new banks.

In addition, what about ATMs that are not functioning thus making people to hop around and use other bank's ATM that is working. Another crucial issue is the restriction on money withdrawal. If someone needs, lets say Rs25,000, and the ATM has withdrawal limit of Rs10,000. In this case, the person would end up making all three permitted transactions there only.

Here is a link to our story on ATM charges: The RBI's ATM usage rule flies in the face of its own Consumer Charter



arun adalja

2 years ago

very good move by moneylife and all must support the move and oppose the rbi decision and compell to cancel the order.

Gopalakrishnan T V

2 years ago

The demand of depositors is genuine.They keep their hard earned savings with banks at 4% rate of interest and banks lend these money at around 14%.The advances turn NPAs and depositors and other tax payers are made to bear the losses.The techonology invasion has helped the banks to reduce the cost of funds and if at all their cost of funds is on the high side it is due to their mismanagement and inefficiency and this cannot be passed on to the depositors for withdrawing their money. It is atrocious and banks cannot justify this. The round table conference arranged by the Money Life on the topic is welcome and IBA which is also a party to banks' non professionalism and exploitative attitude to charge the helpless depositors for anything and everything should be made to make its stand clear on the matter. RBI being the regulator of banks and knowing the in and out of banks' way of functioning and incurring losses on account of staggering NPAs, resorting to heavy borrowings to substitute deposits, poor professionalism in managing the Asets and Liabilities of banks etc cannot simply allow the banks to charge the depositors for covering their inefficiencies. The round table conference being convened at the initiative of Money Life can definitely sort out the issues arising out of the proposed move to Charge the depositors for their withdrawals of mooney through ATM.It is good that Money Life fights the issue on behalf of depositors. Even the issue of NPAs needs to be openly fought by all stakeholders of banks particularly depositors and tax payers.

Rights of air passengers published on DGCA website

Information on Grievance Redressal Mechanism, names of nodal officers and contact numbers would be shared with the public on the portal


Minister for Civil Aviation, Ashok Gajapathi Raju Pusapati launched today a 'Know Your Rights' (KYR) portal of the Directorate General of Civil Aviation (DGCA) to mark 100 days of the new government.


The Internet address of the portal is:




DGCA said that it would provide information on the rights of passengers in cases of delays, cancellation and denied boarding, lost, delayed, misplaced and damaged baggage; and on matters related to booking, airfare components and refund of air tickets. The information on availability of the Grievance Redressal Mechanism, names of nodal officers and contact numbers would be shared with the public on the portal.


The categories under which information is given in the portal include: travel issues, special assistance, advisory for passengers, grievance redressal mechanism, disruptive passengers, tips for healthy flights.


The portal is text-based and for professional users, there is invariably a pdf file to download at the bottom giving full details. The airlines covered for grievance redressal include: Air India, Jet Airways, SpiceJet, Go Air, Indigo, Air Costa and Air Asia.


Air passengers can now read the fine print on the Internet from the DGCA portal and Know their Rights as paying passengers. A screenshot from the portal is given below:




Damera Rama Krishna Rao

1 year ago

Damera Rama Krishna Rao,
makeMytrip ID No.IN141B6S121123
China Eastern E-Ticket No. 781 5856476805-06
Airline PNR NBGK5C

E mail I D. [email protected]

Dear sirs,
Sub: Request to replace the amount spent for onward journey.
Ref: E-Ticket No. 781 5856476805-06 PNR NBGK5C

On 22nd May 2015 on makeMytrip ticket , makeMytrip ID No.IN141B6S121123
vide your E-Ticket No.781 5856476805-06 PNR NBGK5C I have landed on Kunming
airport MU556 KOLKATA/CCU KUNMING Booking No. 39. and took my my luggage
and went to the counters for my onwards journey to OSAKA by MU747. There in the airport
the counter persons are not welverced with English and were unable to direct me to the exact counter where I can check in and get my boarding pass. They were unable to direct me going through the E Ticket and in the mean while the connecting flight has gone. I missed my flight with out my fault. I requested the staff to consider reschedule of my journey. They told me that my ticket refered is no long valied for the onward journey and I am compelled to buy tickets MU756 ETKT7818503099338/1 BD.no 136 to PU DONG and MU9821 ETKT 7814486726125/1

On 2nd June 2015 while I approached for a boarding pass in OSAKA for my flight MU730 the staff told me that I can make use of part of ticket as I did not boardMU-747 on 22nd. May 2015. When a made a protest for that and insisted that I can use the ticket for my return journey at last gave a boarding pass at the last minute of depasture. I regret very much to inform you that your good staff at international air port should have a reasonable English listening and speaking ability.In this connection I request you to refund the amount I paid for MU756 ETKT7818503099338/1 BD.no136 to PU DONG and MU9821 ETKT 7814486726125/1 rescheduling my ticket I bought from makeMytrip.

Thanking you,

Damera Rama Krishna Rao.

Surjit Singh Uppal

1 year ago

makemytrip.com booking ID-NF2203453311022,22nd.oct,15,mum-dli,Indigo-176, arrival dli-15.40hrs.dli-dehradun,SG-2329,dep.dli-18.50 hrs.,resheduled by Spice jet to SG-2327,dep.dli-15.10hrs.Not possible to board flt.advised by makemytrip @spice jet to cancel this flt,and no Deduction will be done.spice jet refunded Rs.2435/,but make my trip deducted Rs.800/-, will refund only Rs.1650/-,PL.take nacessary action.thanks.
anita uppal

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