Chest Pain

Chest pain can be a distressing symptom that can strike substantial fear and anxiety in the suffering individual. There are many harmless conditions that cause chest pain but several serious ones as well. Regardless of the cause, ones should be cautious and if any doubt should seek medical attention.

Causes of Chest Pain

Chest pain can have many causes both benign and serious. Medical evaluation is commonly required to make a proper diagnosis. Here is a sampling of some of these causes:

Heart-related causes

• Myocardial infarction or Heart attack – this occurs when there is a blockage in the arteries (vessels) that supply blood to the heart muscle. It presents as the classical crushing or tight gripping type of chest pain and may radiate up to the jaw or down to the left arm. The patient may be nauseous or sweaty. This is always the predominant concern in patients with underlying conditions like diabetes and high blood pressure or with risk factors such as smoking or family history.
• Pericarditis – Inflammation of the lining of the heart that can be due to medication effects, systemic illnesses such as lupus or infection.
• Aortic dissection – tearing of the largest artery in the body; this type of chest pain will normally radiate to the back and may be accompanied by other symptoms such as dizziness. This is extremely uncommon.

Lung-related causes

• Pulmonary embolism – a blood clot in the lungs which may cause chest pain on breathing in. This can be a life threatening emergency.
• Pneumonia – infection in the lung tissues causing lower chest pain especially on deep breathing and accompanied by fever and cough and sometimes bloody sputum.
• Costochondritis – generally benign inflammation of the breast bone and cartilage joint of ribs causes a sharp chest pain on coughing, breathing in and on localized pressure of the affected rib.
• Pleuritis – a thin sac-like membrane surrounds the lungs and allows it to glide easily during breathing. Inflammation of this is pleuritis and may be caused by infection, lung cancer, chest trauma and various autoimmune disorders. Many times this is benign.

Chest Pain related to other Body Systems

• Most Common is – musculoskeletal pain such as muscle strains from exercise or strenuous cough, sneezing, vomiting, trauma or other activities.
• Gastrointestinal condition such as gastro-esophageal reflux disease (GERD) commonly known as heartburn– which produces a burning type of chest pain that occurs when acid from the stomach comes up into the esophagus, stomach ulcers, irritable bowel syndrome, gallstones and gallbladder inflammation, and inflammation of the pancreas.
• Shingles – this declares itself as a regional skin rash that occurs in a patient who has previously suffered chicken pox.
• Anxiety and panic attacks– rapid heartbeats that occur during episodes of stress may be associated with chest pain and dizziness.

When Is Chest Pain an Emergency?

An ambulance should be called if the chest pain is:

• New or severe
• Crushing in nature and occurs in the center of the chest behind the breastbone
• Radiates to another area of the body such as down the left arm, upwards to the jaw or to the back
• Persists longer than 10 minutes
• Increasing in severity especially with physical activity
• Occurring in a person with underlying conditions that predispose them to a heart attack such as diabetes or high blood pressure
• Associated with other symptoms such as difficulty breathing, palpitations or irregular heart rhythm, coughing up blood, dizziness, nausea, sweating and cold clammy skin
• Any pain that is distressing

Remember, having chest pain does not necessarily mean you are having a heart attack. Most people who go to the emergency room with chest pain are not having a heart attack. Their pain is usually caused by less serious problems as listed above such as muscle pain, heartburn, or anxiety. Even so, you should not take any chances. People often delay seeking help for a heart attack because they think the symptoms are not serious or will go away. When they do that, they risk permanent damage to their heart – or even death.

What will Happen at the Emergency Room?

The first priority is for the doctor to ensure that the patient is stable. This means assessing the patient’s airway, breathing, and circulation including blood pressure, oxygen levels, heart rate and rhythm among other things. The likely cause of the chest pain is deduced based on the patient’s description of symptoms, previous medical history, and a focused physical examination especially to be performed on the heart and lungs and related systems.

Other tests may be done according to the initial suspected diagnosis. These tests include, but are not limited to:

• An electrocardiogram (EKG) – This test displays the electrical activity in heart muscle and can help doctors determine if you are suffering a heart attack.
• Blood tests – During a heart attack, the heart releases certain chemicals. If these chemicals are in your blood, it might mean you are having a heart attack.
• Chest X-ray
• CT scan or VQ scan
• A stress test – During a stress test, you are requested to run on a treadmill while you also have an EKG. Physical activity makes the heart work harder thus increases its demand for blood. By observing changes in electrical activity doctors determine if that supply is adequate. If you are immobile, your doctor might do this test by giving you a nuclear medicine isotope and another drug to make your heart pump faster.
• Cardiac catheterization– During this test, the doctor places a thin tube into a blood vessel in your leg. Then he or she maneuvers the tube up to your heart and injects a dye which will reveal blockages on imaging. This is also called cardiac angiogram.
• Others

Depending on the results of this comprehensive evaluation the patient will be referred on to the respective specialist for the appropriate management.