Although it’s thought that chest pain is due to heart related causes, it could also be due to many other causes. It could be a problems in the muscles, nerves, lungs, ribs, esophagus and even stomach. Any pain you get from your neck to upper abdomen can be a chest pain. Depending on the nature and place of the pain the cause of the chest pain can be predicted. There are many life threatening causes of chest pain. Therefore, any unexplained causes of chest pain should be confirmed by having a doctor evaluate you.
Some most common causes for chest pain
Heart related causes of chest pain
- Coronary artery disease- you can get angina or heart attack due to problems in your coronary arteries.
- Angina- chest pain you get when heart muscle doesn’t get enough blood supply. This occur dues o build up of fatty deposits in blood vessels which supply heart.
Symptoms of chest pain in angina
- Central chest pain
- May radiate to jaw and arms
- Difficulty in breathing
Angina can be a stable or unstable angina. The pain differs in nature.
Chest pain in stable angina– Sudden onset chest pain when doing exercise or when in emotional excitement.
Increases over time but doesn’t last longer than 20 minutes.
Relieves with resting.
Management- 1. Lifestyle modification and risk factor control. Ex. Smoking reduction,exercising.
2.Medications ex-: GTN, amlodipine, nicorandil, ivabradine…
Chest pain in unstable angina– Recent onset chest pain (<24 hours) or worsening of a previous angina.
Triggered with low amount of physical activity or even at rest.
Last more than 20 minutes.
Gradually increasing pain with time and doesn’t relieve by resting.
It’s important that you seek immediate medical care. Needed medical intervention
will be done by a trained medical team.
- Heart attack (myocardial infarction)- Chest pain due to blockage of blood supply to the heart causing death of heart muscle.
Symptoms of chest pain in heart attack-
- New/sudden onset, severe crushing like/squeezing, tightening, chocking or heavy, contracting pain in chest or behind the breastbone.
- Pain increasing with time
- Mostly lasting more than 20 minutes (can be less)
- Tightening type of pain radiating to other body parts like arm, jaw, hand.
Associated -: Vomiting, sweating, palpitation, faintishness,
Difficulty in breathing
Most severe cardiac cause of death over the world.
Just like in unstable angina emergency medical attention is a must. Call an ambulance immediately.
What to do if you get a sudden sever chest pain (heart attack or suspected unstable angina) at home-
- Immediately stop what you are doing and rest/sit.
- Call someone for help.
- If you are already on angina medications take them according to your doctor’s instructions.
- Call an ambulance or go to the nearest hospital as soon as possible.
- Chew for 300 mg asprin (if available) until you reach the hospital or the ambulance –
don’t do this if you are allergic to aspirin or your doctor has told you not to
Medical management of sudden severe chest pain at hospital… (link)-
- immediate medical management-
Oxygen will be given if saturating reduced (>90%)
These will be given immediately.
Stat dose of 300 mg Aspirin
40-80 mg Atorvastatin
pain relief medications. ex – IV morphine + drugs for vomiting and nausea
- Needed investigations/tests will be done ex. ECG, Cardiac enzyme assay ( troponin I).
- According to investigation findings can find out if it’s a heart attack or unstable angina. Then specific management is done according to the cause.
- If heart attack (STEMI- ST elevated myocardial infarction on ECG findings/ a type of MI)
thrombolysis will be done (dissolving blood clots)
-Drugs -: streptokinase. Tenecteplase.
- If unstable angina or NON STEMI (a type of MI) –
Drugs- mainly- Heparin (prevent clotting of blood, not dissolving of clots like in MI)
Surgical management of severe coronary artery diseases:
PCI-percutaneous coronary intervention/angioplasty with a stent.
CABG- coronary artery bypass grafting.
How ever these managements and drugs can vary depending on the region.
- Myocarditis- inflammation (just like an ordinary swelling and reddening of site of a wound) or infection of cardiac muscle. Myocarditis can cause due to many reasons like infective causes like bacterial, fungal, parasitic, connective tissue diseases like SLE, rheumatoid arthritis, PAN
Symptoms of chest pain due to myocarditis are-
chest pain with associated –
- fast heart beat
- difficulty in breathing
Management- mainly focused on treating the underlying cause of myocarditis.
Drugs – corticosteroids will be given to reduce inflammation.
ACE inhibitors/ARB and Beta blockers- Cardiac medications.
Antibiotic therapy for infection.
Diuretic therapy if fluid overload present.
3.Pericarditis-inflammation or infection of the covering of the heart.
Symptoms of chest pain in pericarditis – stabbing type pain,
Increases with deep breathing, swallowing and lying on your back.
Can be relieved by bending forward.
Acute pericarditis will be mostly given 700-1000mg Asprin three times daily or ibuprofen 600-800 mg three times daily for 1 to 2 weeks together with colchicine( 0.5mg twice daily for three months)
It will be further managed according to cause, severity and duration.
4.Coronary artery dissection- this is a rare condition which may cause chest pain. A deadly condition.
Symptoms of chest pain-
sudden , severe, tearing or ripping sensation.
- Lung problems causing chest pain –
- Pleuritis – inflammation of lining of lungs. Can be caused due to bacterial, viral, infections or pulmonary embolism or pneumothorax.
Underlying cause for pleuritic should be controlled in management.
- Pleural effusion- accumulation of excess fluid in the lining of the lungs.
Pleural fluid can be aspirated and removed.
- Pneumonia –
This can cause chest pain when breathing, alone with the pain dry or cough with phlegm, breathlessness and fever may be seen.
1.oxygen can be given if saturation decreased.
2.antibiotics- first prophylactic antibiotics will be given without waiting for investigation reports. After reports are available will be given the antibiotic specific for the organism which causes the pneumonia in you.
- Pulmonary embolism –
lodging of a blood clot in the lungs or vessels of the lungs. Common in people with deep vein thrombosis. They can easily detach and go and lodge in vessels of lungs.
Management – anticoagulants and drugs to dissolve clots (thrombolytic ) will be given.
- Pneumothorax- caused by injury or trauma to chest.
A medical emergency!! Seek immediate medical care.
- Asthma- sometimes can cause chest pain.
- COPD- mostly seen in chronic smokers. Due to blockage of airways. Sometimes can cause chest pain
- Gastric causes of chest pain.
- Gastritis (Gastro esophageal reflux disease) –
The pain in this is usually referred to as heart burn. It’s a burning sensation in the chest and throat. This can be confused with a chest pain due to heart problems because they share the same nervous.
- Gastric ulcer- can feel as chest pain due to ulcers in upper part of stomach and lower part of esophagus.
- Gallbladder problems- chest pain after eating, right lower chest area pain is common.
- Muscle related chest pain-
A fall, an accident or lifting heavy weights can cause chest pain. Even muscle overuse or hard coughing and sneezing can cause this. This will be an aching kind. It’s a continuous type of pain.
Management – the ‘RICE’ procedure can be done for first 24-48 hours following the injury
R – REST- avoid strenuous activities for these times.
I-ICE- apply ice wrapped in a cloth over the aching muscles of the chest.
C- COMPRESSION- wrapping a compression bandage around the torso with the advice of a medical practitioner.
(wrapping in a wrong way can cause further damage)
E- ELEVATION- sit upright as much as possible, using two pillows to keep the body propped up when sleeping.
Drugs – NSAIDS- non steroid anti-inflammatory drugs can be used. Ex. Ibuprofen
- Shingles – disease caused by secondary activation of chicken pox virus.
(due to varicella zoster virus). Therefore likely cause of chest pain in someone who recently had chicken pox.
It’s a sharp band like pain. After sometime a rash may appear on one side of body limited to a particular area, which doesn’t cross to the midline of the body to go to the other side.
- Bone related causes- injured, bruised or broken rib can cause chest pain.
- Costochondritis -inflammation of the cartilage that joins your rib to the breastbone.
- Psychological causes of chest pain-
Panic attacks and anxiety-
- intense fear with chest pain
- Rapid breathing
- Profuse sweating
- Difficulty in breathing and dizziness
- Fear of dying