Overview of Chest Pain
If you are having severe pain, crushing, squeezing, or pressure in your chest that lasts more than a few minutes, or if the pain moves into your neck, left shoulder, arm, or jaw, “go immediately to a Hospital Emergency Department”. “Don’t drive yourself, call an ambulance”. It is a bit difficult even for a doctor or other medical professional to tell what is causing chest pain and whether it is life-threatening. Seeking immediate care may be lifesaving. Heart attack symptoms may include:-
- Chest Pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
Causes of Chest Pain
While the patient may be worried about a heart attack; there are many other causes of pain in the chest that the health care professional will need to consider. Some diagnoses are life-threatening, while others are less dangerous.
Heart or blood vessel problems
- Angina or a heart attack. The most common symptom is chest pain that may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.
- A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body (aortic dissection) causes sudden, severe pain in the chest and upper back.
- Swelling (inflammation) in the sac that surrounds the heart (pericarditis) causes pain in the center part of the chest.
- A blood clot in the lung (pulmonary embolism)
- Collapse of the lung (pneumothorax)
- Pneumonia causes a sharp chest pain that often gets worse when you take a deep breath or cough.
- Swelling of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.
Digestive System Problems
- Spasms or narrowing of the esophagus (the tube that carries food from the mouth to the stomach)
- Gallstones cause pain that gets worse after a meal (most often a fatty meal)
- Heartburn or Gastro Esophageal Reflux (GERD)
- Stomach ulcer or gastritis (burning pain occurs if your stomach is empty and feels better when you eat food)
Other Causes of Chest Pain:
- Panic attack, which often occurs with fast breathing
- Inflammation where the ribs join the breast bone or sternum (costochondritis)
- Shingles, which causes sharp, tingling pain on one side that stretches from the chest to the back, and may cause a rash
- Strain of the muscles and tendons between the ribs
Typical approach to chest pain involves ruling out the most dangerous causes: heart attack, pulmonary embolism, thoracic aortic dissection, esophageal rupture, tension pneumothorax and cardiac tamponade. By elimination or confirmation of the most serious causes, a diagnosis of the origin of the pain may be made. Often, no definite cause will be found and reassurance is then provided. A number of tests may be carried out :-
- X-rays of the chest and/or abdomen (CT scanning may be better but is often not available). Routine X-rays and CT may however not be needed.
- An Electrocardiogram (ECG)
- V/Q Scintigraphy or CT Pulmonary Angiogram(when a pulmonary embolism is suspected)
- Blood tests:
- Complete blood count
- Electrolytes and renal function (creatinine)
- Liver enzymes
- Creatine kinase (and CK-MB fraction in many hospitals)
- Troponin I or T (to indicate myocardial damage)
- D-dimer (when suspicion for pulmonary embolism is present but low)
- Serum Lipase to exclude acute pancreatitis
Treatment of Chest Pain
Treatment for chest pain depends upon the cause. Situations may require immediate evaluation, diagnosis, and treatment to occur at the same time, but when there is opportunity, the sequence of history, physical examination, testing, diagnosis, and treatment should be followed.
- Questions to Ask Your Doctor About Chest Pain (everydayhealth.com)
- Key Symptoms For Embolism: Difficulty Breathing, Chest Pain, And Cough (medicalnewstoday.com)