Chest pain

Chest pain is one of the most common symptoms that bring an individual to the emergency department. Seeking immediate care may be lifesaving, and considerable public education has been undertaken to get patients to seek medical care when chest pain strikes. You may be worried that you are having a heart attack, but there are many other causes of pain in the chest that the doctor will consider. Some diagnoses of chest pain are lifethreatening, while others are less dangerous.

Deciding the cause of chest pain is sometimes very difficult and may require blood tests, X-rays, CT scans and other tests to sort out the diagnosis. Often though, a careful history taken by the doctor may be all that is needed.There are many causes of chest pain, and while many are not serious, it may be difficult to distinguish a heart attack, pulmonary embolus, or aortic dissection, from another diagnosis that is not life-threatening, like heartburn. For that reason, individuals are routinely advised to seek medical evaluation for most types of chest pain.

While each cause of chest pain has classic symptoms and signs, there are enough variations in symptoms that it may take specific testing to reach a diagnosis. These tests will depend on the your current health and the healthcare professionals index of suspicion as to what the diagnosis might be.

Treatment for chest pain depends upon the cause.

It is best to be safe. Always seek medical care if you are having chest pain.

 

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Chest pain has many possible causes, all of which need medical attention.

Heart-related causes

Examples of heart-related causes of chest pain include:

  • Heart attack. A heart attack results from blocked blood flow, often from a blood clot, to your heart muscle.
  • Angina. Angina is the term for chest pain caused by poor blood flow to the heart. This is often caused by the buildup of thick plaques on the inner walls of the arteries that carry blood to your heart. These plaques narrow the arteries and restrict the heart's blood supply, particularly during exertion.
  • Aortic dissection. This life-threatening condition involves the main artery leading from your heart (aorta). If the inner layers of this blood vessel separate, blood is forced between the layers and can cause the aorta to rupture.
  • Pericarditis. This is the inflammation of the sac surrounding your heart. It usually causes sharp pain that gets worse when you breathe in or when you lie down.

Digestive causes

Chest pain can be caused by disorders of the digestive system, including:

  • Heartburn. This painful, burning sensation behind your breastbone occurs when stomach acid washes up from your stomach into the tube that connects your throat to your stomach (esophagus).
  • Swallowing disorders. Disorders of the esophagus can make swallowing difficult and even painful.
  • Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder or pancreas can cause abdominal pain that radiates to your chest.

Muscle and bone causes

Some types of chest pain are associated with injuries and other problems affecting the structures that make up the chest wall, including:

  • Costochondritis. In this condition, the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed and painful.
  • Sore muscles. Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related chest pain.
  • Injured ribs. A bruised or broken rib can cause chest pain.

Lung-related causes

Many lung disorders can cause chest pain, including:

  • Pulmonary embolism. This occurs when a blood clot becomes lodged in a lung (pulmonary) artery, blocking blood flow to lung tissue.
  • Pleurisy. If the membrane that covers your lungs becomes inflamed, it can cause chest pain that worsens when you inhale or cough.
  • Collapsed lung. The chest pain associated with a collapsed lung typically begins suddenly and can last for hours, and is generally associated with shortness of breath. A collapsed lung occurs when air leaks into the space between the lung and the ribs.
  • Pulmonary hypertension. This condition occurs when you have high blood pressure in the arteries carrying blood to the lungs, which can produce chest pain.

Other causes

Chest pain can also be caused by:

  • Panic attack. If you have periods of intense fear accompanied by chest pain, a rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness and a fear of dying, you may be experiencing a panic attack.
  • Shingles. Caused by a reactivation of the chickenpox virus, shingles can produce pain and a band of blisters from your back around to your chest wall.

 

Risk factors for atherosclerotic heart disease (also known as coronary artery disease)

  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Family history

Risk factors for pulmonary embolus (blood clot to the lung)

  • Prolonged inactivity such as bed rest, long car or airplane trips
  • Recent surgery
  • Fractures
  • Birth control pill use (particularly if the patient smokes cigarettes)
  • Cancer

Risk factors for aortic dissection

  • High blood pressure
  • Marfan syndrome
  • Ehlers-Danlos syndrome
  • Polycystic kidney disease
  • Cocaine use
  • Pregnancy

Chest pain can cause many different sensations depending on what's triggering the symptom. Often, the cause has nothing to do with your heart — though there's no easy way to tell without seeing a doctor.

Heart-related chest pain

Although chest pain is often associated with heart disease, many people with heart disease say they experience a vague discomfort that isn't necessarily identified as pain. In general, chest discomfort related to a heart attack or another heart problem may be described by or associated with one or more of the following:

  • Pressure, fullness, burning or tightness in your chest
  • Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms
  • Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity
  • Shortness of breath
  • Cold sweats
  • Dizziness or weakness
  • Nausea or vomiting

Other types of chest pain

It can be difficult to distinguish heart-related chest pain from other types of chest pain. However, chest pain that is less likely due to a heart problem is more often associated with:

  • A sour taste or a sensation of food re-entering your mouth
  • Trouble swallowing
  • Pain that gets better or worse when you change your body position
  • Pain that intensifies when you breathe deeply or cough
  • Tenderness when you push on your chest
  • Pain that is persistently present for many hours

The classic symptoms of heartburn — a painful, burning sensation behind your breastbone — can be caused by problems with your heart or your stomach.

Chest pain doesn't always signal a heart attack. But that's what emergency room doctors will test for first because it's potentially the most immediate threat to your life. They may also check for life-threatening lung conditions — such as a collapsed lung or a clot in your lung.

Immediate tests

Some of the first tests your doctor may order include:

  • Electrocardiogram (ECG). This test records the electrical activity of your heart through electrodes attached to your skin. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that you have had or are having a heart attack.
  • Blood tests. Your doctor may order blood tests to check for increased levels of certain proteins or enzymes normally found in heart muscle. Damage to heart cells from a heart attack may allow these proteins or enzymes to leak, over a period of hours, into your blood.
  • Chest X-ray. An X-ray of your chest allows doctors to check the condition of your lungs and the size and shape of your heart and major blood vessels. A chest X-ray can also reveal lung problems such as pneumonia or a collapsed lung.
  • Computerized tomography (CT scan). CT scans can spot a blood clot in your lung (pulmonary embolism) or make sure you're not having aortic dissection.

Follow-up testing

Depending upon the results from these initial tests, you may need follow-up testing, which may include:

  • Echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart in motion. A small device may be passed down your throat to obtain better views of different parts of your heart.
  • Computerized tomography (CT scan). Different types of CT scans can be used to check your heart arteries for blockages. A CT coronary angiogram can also be done with dye to check your heart and lung arteries for blockages and other problems.
  • Stress tests. These measure how your heart and blood vessels respond to exertion, which may indicate if your chest pain is heart-related. There are many kinds of stress tests. You may be asked to walk on a treadmill or pedal a stationary bike while hooked up to an ECG. Or you may be given a drug intravenously to stimulate your heart in a way similar to exercise.
  • Coronary catheterization (angiogram). This test helps doctors identify individual arteries to your heart that may be narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, either through your wrist or your groin, to arteries in your heart. As the dye fills your arteries, they become visible on X-rays and video.

Treatment varies depending on what's causing your chest pain.

Medications

Drugs used to treat some of the most common causes of chest pain include:

  • Artery relaxers. Nitroglycerin — usually taken as a tablet under the tongue — relaxes heart arteries, so blood can flow more easily through the narrowed spaces. Some blood pressure medicines also relax and widen blood vessels.
  • Aspirin. If doctors suspect that your chest pain is related to your heart, you'll likely be given aspirin.
  • Thrombolytic drugs. If you are having a heart attack, you may receive these clot-busting drugs. These work to dissolve the clot that is blocking blood from reaching your heart muscle.
  • Blood thinners. If you have a clot in an artery feeding your heart or lungs, you'll be given drugs that inhibit blood clotting to prevent the formation of more clots.
  • Acid-suppressing medications. If your chest pain is caused by stomach acid splashing into your esophagus, the doctor may suggest medications that reduce the amount of acid in your stomach.
  • Antidepressants. If you're experiencing panic attacks, your doctor may prescribe antidepressants to help control your symptoms. Psychological therapy, such as cognitive behavioral therapy, also might be recommended.

Surgical and other procedures

Procedures to treat some of the most dangerous causes of chest pain include:

  • Angioplasty and stent placement. If your chest pain is caused by a blockage in an artery feeding your heart, your doctor will insert a catheter with a balloon on the end into a large blood vessel in your groin, and thread it up to the blockage. Your doctor will inflate the balloon tip to widen the artery, then deflate and remove the catheter. In most cases, a small wire mesh tube (stent) is placed on the outside of the balloon tip of the catheter. When expanded, the stent locks into place to keep the artery open.
  • Bypass surgery. During this procedure, surgeons take a blood vessel from another part of your body and use it to create an alternative route for blood to go around the blocked artery.
  • Dissection repair. You may need emergency surgery to repair an aortic dissection — a life-threatening condition in which the artery that carries blood from your heart to the rest of your body ruptures.
  • Lung reinflation. If you have a collapsed lung, doctors may insert a tube in your chest to reinflate the lung.

Many deaths can be prevented because coronary heart disease is related to certain lifestyle aspects, according to the American Heart Association. However, certain factors beyond our control, like family history and age, increase our risk for heart disease. Some controllable risk facts are:

Smoking:

The American Medical Association says smoking is responsible for one in four cases of cardiovascular disease. Quitting smoking can be the most important thing you do for your heart and blood vessels. There are smoking cessation classes available through Trinity Health System.

Obesity:

The American Heart Association says obesity increases your risk of heart disease, even if you have no other risk factors. Maintaining a healthy weight through a low-fat and low-cholesterol diet can reduce your risk of heart disease. Be aware of the amount of fat and saturated fat in foods, especially processed foods. Learn to read food labels and ask your doctor or registered dietitian how to limit the total amount of fat in your diet to no more than 30 percent of your total calories.

Physical inactivity:

Regular aerobic activity plays a significant role in preventing heart and blood vessel disease. You don't have to spend hours every day at the gym either. Even a 30-minute walk, three or four times a week, can be beneficial.

High blood pressure:

Sometimes, high blood pressure can be controlled through lifestyle changes like having a healthy weight, increasing physical activity, reducing sodium intake, avoiding smoking and drinking alcohol only in moderation. Your doctor may decide, however, that -- along with diet and lifestyle changes -- medication is needed as well.

High cholesterol:

According to the American Dietetic Association, cholesterol is not generally found in plant foods. Vegetables, fruits, grains and cereals are usually healthy choices - provided you don't load them up with high-fat sauces and dressings. When choosing animal protein foods, look for ones that are low in saturated fat and cholesterol, like the leanest cuts of meat, poultry without the skin, most fish, skim milk, and low- and non-fat dairy products. If you have a high level of cholesterol that can't be brought down by diet or exercise. your doctor might prescribe medication.

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