Chest Pain
Authored by Dr.Ajay Tripuraneni on 5 May 2013 - 11:37.Pain in the chest is a common symptom that generates significant anxiety. As chest pain can be caused by a wide variety of conditions ranging from less serious conditions such as Heart burn (gas) to life threatening conditions such as heart attack. It is important to get appropriate check up done from a qualified professional. Based on the cause chest pain can vary in location, intensity and quality (stabbing, sharp, dull). Some need to be recognized immediately and treated right away.
With diabetes, high blood pressure and weight gain on the rise in India, cardiac (heart attack) causes for chest pain needs to be ruled out.
Some of the common causes or dangerous conditions are enumerated here. This list is in no way a complete list, please consult your doctor, if you are experiencing chest pain.
Heart related:
- Heart pain (angina)
- Heart attack ( myocardial infarction)
- Inflammation of the sac surrounding the heart (pericarditis)
Lung related:
- Lung infection (pneumonia)
- Blood clot in the lung
- Cancer of the lung
Food pipe/digestive tract (esophagus, mouth) related:
- Gas in the digestive tract
- Heart burn (acid reflux)
- Spasm of the food pipe (esophageal spasm)
- Inflammation of the food pipe ( esophagitis)
- Cancer of the food pipe (esophageal cancer)
Muscle and bone related:
- Chest wall pain (from bone and muscle pain)
- Pulled muscle
- Inflammation of the cartilage of the ribs
- Broken ribs
Other causes:
- Anxiety attack
- Infection of chest wall from herpes virus (shingles)
Picture of Coronary artery in normal and in a patient with narrowing (modified from drawings of Icewalker CS)
Angina (heart pain) happens when there is not enough blood supply (due to narrowing of the coronary artery) for the amount of work your heart is doing. It is usually a chest discomfort that is present in the middle of the chest, or the left side. The discomfort can go to the left or right arm, neck or jaw. The discomfort comes on with activity, exercise, or emotional stress. It gets better with rest or nitroglycerin.
What is a heart attack?
Complete blockage in a coronary artery causes lack of blood supply and nutrients to the heart. This causes the muscle to die over a few hours and causes heart attack.
What is the difference between angina and heart attack?
Angina pain tends to get better when you rest or take a nitro, heart attack lasts longer and is present at rest and may not improve with nitro. The pain location is similar to angina but is much more severe, it can be associated with sweating, nausea, urge to go to the bathroom, or trouble breathing.
Some useful links regarding chest pain from different specialty societies. These will help you understand chest pain.
1. Angina (chest pain from heart related conditions):
2. Heart attack:
3. Coronary artery spasm:
4. Gas in the digestive tract:
http://www.gastro.org/patient-center/digestive-conditions/gas-in-the-digestive-tract
5. Heart burn:
http://www.gastro.org/patient-center/digestive-conditions/heartburn-gerd
The tests that a doctor will recommend to diagnose the pain are:
Electrocardiogram
Blood test to check for heart attack (cardiac enzymes)
Blood counts for anemia
Chest x ray
Ultrasound of your heart based on your history and risk for heart problems.
Is there any differentiation between heart pain, muscle pain and bone pain?
Not always but a few clues can gear you toward one or the other, heart pain usually occurs when you walk, run or exercise. Heart pain gets better when you rest. Muscle pain usually present all the time (does not change with activity) and when you push on the chest wall it hurts .
What are the symptoms for heart burn?
Usually heart burn can feel like a sour sensation in your mouth, you can have upper stomach (belly) pain with it. It can happen with certain foods and drinks (carbonated drinks such as Pepsi soda, spicy foods). Heart burn behaves like indigestion. Beware sometimes heart attack can behave like indigestion, especially if you are elderly, women, diabetic or having a heart attack in the inferior wall.
What is esophageal spasm?
Sometimes the esophagus (food pipe that carries food from your mouth to the stomach) can spasm causing chest pain that is similar to angina. You can have trouble swallowing. This pain can also be relieved by nitroglycerin at times.
What are the usual symptoms of a tear of the blood vessel (aorta)?
It is a sudden onset of chest pain, goes to your back. Your blood pressure can be really high. This is an emergency, and you should call an ambulance right away.
Based on the above symptoms or history can you come to a diagnosis (conclusion) without any further work up?
No, they are like a guide to your doctor and help your doctor focus on one part of the body or the other. It also helps to guide your doctor in ordering appropriate tests.
How is chest pain treated?
Treatment varies depending on the cause of chest pain.
Please see the articles related to each condition for available treatment. If you have chest pain, please consult with your doctor.
The above information is for general education purpose only.
