Chest Pain

1 Chest Pain Summary

Chest pain is a symptom experienced by many people and is a common reason for emergency room visit. The pain may be felt anywhere in the chest between the shoulders and the bottom of ribs.

The pain varies in duration, intensity, location, and quality in different people. The pain may be a dull ache in some people, while others feel it as a sharp pain in the chest. Many people consider this as a symptom of heart attack, as chest pain is a well-known sign of heart attack.

The causes of chest pain are many and it is important to diagnose the exact cause. Some causes of chest pain are not serious while others, particularly those related to heart attack or aortic dissection, are potentially life-threatening. In these cases, getting immediate medical attention is a life-saver.

The warning signs for immediate medical attention are when the pain is:

  • tight or heavy on the chest
  • lasts for a longer duration, often more than 15 minutes
  • radiating to the back, jaws or arms
  • associated with other symptoms like breathlessness or nausea

People who are at an increased risk of coronary heart disease should make it a point to immediately report to the emergency room if any of the above indications are present.

Causes of chest pain are many. It is usually classified into those related to heart, digestive, lungs, muscles, and bones. Shingles are also known to cause chest pain. Panic attack, characterized by episodes of fear, may also lead to chest pain. Each of the above-mentioned causes is associated with other symptoms.

Chest pain related to heart problems are associated with:

  • Tightness of chest
  • Pain in the jaws, arms, or back
  • Lightheadedness
  • Fatigue
  • Breathlessness
  • Pain in the abdomen
  • Nausea

Chest pain caused by other conditions may have a different set of symptoms including: 

  • Acid taste lingering in the mouth
  • Difficulty in swallowing
  • Rashes
  • Fever and aches
  • Chills and fever
  • Running nose and cough
  • Panic and anxiety
  • Back pain that radiates to the chest

Pain that starts or worsens with body position, and pain that increases with a cough and deep breathing, are not associated with any heart problems.

Medical history and physical examination are the first steps in the diagnosis of the actual cause of chest pain. Tests are recommended to rule out the possibility of other conditions.

Treatment of chest pain is based on the actual cause of the symptom. Those caused by heart-related problems are treated with medications, cardiac catheterization, and surgery. Antacids are used for heartburn and acid reflux.

If chest pain is caused by collapsed lung, lung re-inflation is recommended. Panic attacks that cause chest pain are controlled by anti-anxiety medications.

In most of the cases, chest pain can be resolved by appropriate treatment of the underlying condition. But, it can also be a symptom of a life-threatening condition that requires medical attention. Once the actual cause is diagnosed, it can be treated to manage the associated condition.

2 Causes

There are many causes for chest pain, and heart problems are one of the most common ones.

The major heart issues that lead to chest pain include:

  • Heart attack – in this condition blood flow to the muscles of the heart is blocked. Thus the heart muscles lose oxygen supply leading to its death. A blood clot is one of the main causes of heart attack or myocardial infarction.
  • Angina – narrowing of coronary arteries reduces the supply of blood to the muscles of the heart. Activity like climbing stairs or brisk walking increases the demand for oxygen by the heart muscles, and narrow arteries fail to provide an adequate amount of blood to the muscle resulting in pain.
  • Pericarditis – this is a condition characterized by the inflammation of the sac surrounding the heart. Pericardial inflammation results in a sudden, sharp pain in the chest.
  • Myocarditis – myocarditis is the inflammation of the muscles of the heart that results in chest pain.
  • Cardiomyopathy – is a disease of the heart muscle which leads to chest pain
  • Aortic dissection – in this condition the inner layer of the aorta, the largest blood vessel, separates. This forces the blood to move between the two layers of the wall of the blood vessel resulting in rupture of the aorta.

Chest pain may also be caused by gastrointestinal or digestive problems.

Some of the common digestive causes are: 

  • Acid reflux or gastroesophageal reflux disease
  • Disorders of the esophagus
  • Problems of gall bladder and pancreas like inflammation
  • Gallstones

Lung disorders are also known to cause chest pain.

Some common lung-related issues are as follows:

  • A blood clot in one of the pulmonary artery results in pulmonary embolism. This reduces the blood flow to the lungs resulting in chest pain
  • Inflammation of the membrane covering lungs is a known cause of chest pain. This pain tends to worsen with a cough or deep breathing.
  • Collapsed lungs can cause a sudden chest pain which lasts for a long time. The collapse of the lung happens when air enters into the space between the lung and ribs.
  • High pressure in the blood vessels carrying blood to the lungs, called as pulmonary hypertension, is another cause of chest pain.

Injuries and problems associated with the muscles and bones that make up the chest wall also result in pain.

This causes pain in the chest:

  • Costochondritis is the painful inflammation of the cartilage that joins the ribs to the breastbone. 
  • Fibromyalgia, a chronic pain syndrome, can cause chest pain
  • Broken ribs or bruised ribs also lead to chest pain.

Shingles and panic attack are also common causes of chest pain. Anxiety and panic attack may lead to chest pain and breathlessness. In some cases, the chest pain is often misunderstood as angina.

Shingle is a viral infection that affects a nerve and the skin area supplied by the nerve. Shingles may lead to chest pain if the virus affects a nerve that supplies the skin on the chest.

3 Diagnosis and Treatment

Somebody with a new, sudden, and unexplained chest pain should ideally get medical help. Diagnosis starts with a medical history and the signs and symptoms associated with chest pain.

This is followed by a physical examination to evaluate the cause of pain. Based on the probable cause of pain, the doctor may suggest certain tests and investigations.

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Some of the common diagnostic tests used are: 

ECG – this technique helps to trace the electrical activity of heart.

Blood tests – blood test helps to confirm conditions like heart attack, deep vein thrombosis, and pulmonary embolism. Measuring the level of troponin in blood is used to confirm a heart attack. This is based on the fact that damaged heart muscles release troponin in the bloodstream.

A D-dimer test is a blood test used to detect fragments of a blood clot. The presence of blood clot indicates deep vein thrombosis or pulmonary embolism, which is confirmed by further investigations.

X-ray of the chest helps to detect pneumonia, lung collapse, and other chest conditions that lead to chest pain.

Myocardial perfusion scintigraphy is a test used to confirm angina. In this method, a small amount of radioactive substance is injected into the person and then traced using gamma camera. The radioactive substance shows a picture of the blood vessels to the heart.

An angiogram is a common method for detecting heart problems. In this method, a dye injected into the blood vessel is traced with the help of an x-ray. It helps in providing a detailed picture of the blood vessel and also in detecting narrowing of arteries, one of the causes of chest pain.

Other imaging techniques like isotope scan and computerized tomography pulmonary angiogram (CTPA) are used to detect issues with blood supply to the lungs. This often reveals pulmonary embolism and other lung issues that lead to pain in the chest.

A peptic ulcer that causes chest pain is detected using endoscopy. This method reveals inflammation or ulcers in the gut. Treatment method used to control chest pain depends on the underlying cause of pain. Some common treatment methods are medications, cardiac catheterization, and surgery.

Medications that help in relieving chest pain by controlling the underlying condition include:

  • Nitroglycerine helps in relaxation of coronary arteries, allowing easy flow of blood through the blood vessels. Certain blood pressure medications also help in relaxation of arteries.
  • Aspirin is a common medication used to treat chest pain caused by heart-related issues.
  • Antibiotics are recommended to treat pneumonia and other infections that lead to chest pain
  • Drugs that dissolve clots in blood vessels is commonly used to open up the arteries. It will also prevent the clot from reaching the heart muscle.
  • Blood thinners help in preventing the formation of blood clots.
  • Acid-suppressing medications are used to control chest pain caused by GERD
  • Anti-depressants are commonly recommended to control panic attacks that cause chest pain.

Balloons and stents are used in cardiac catheterization methods to reopen the artery that is closed or narrowed. Stents help to keep the artery open for easy flow of blood. Bypass surgery is used to provide an alternative route for blood flow.

Aortic dissection is treated by emergency surgical repair. Collapsed lung is treated by lung reinflation in which a tube inserted into the chest is used to reinflate the lungs.

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