Causes of chest pain

Most people think that chest pains are due to heart related causes. However many other causes other than heart problems can also cause chest pains. It can 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, we recommend consulting a doctor to confirm any unexplained causes of chest pain.

In this article we will discuss some most common heart related causes for chest pain.

1. Heart related causes of chest pain

1.1 Coronary artery disease

You can get angina or heart attack due to problems in your coronary arteries. Next we will explain the specific symptoms of these heart problems so that you can suspect the cause even at home before consulting your doctor.

Angina

Angina is the chest pain you get when heart muscle doesn’t get enough blood supply. This occur due to the build up of fatty deposits in blood vessels which supply your heart.

Symptoms of chest pain in angina
  • Heavy
  • Tightening
  • Gripping
  • Central chest pain
  • May radiate to jaw and arms
  • Difficulty in breathing

Angina can be a stable or an unstable angina. The pain in each differs in nature.

Chest pain in stable angina

This will be a sudden onset chest pain when doing exercise or when in emotional excitement. It may increases over time but doesn’t last longer than 20 minutes. The good thing is it relieves with resting.

Management
  1. The best form of management for this is lifestyle modification and risk factor control. Ex. Smoking reduction, exercising.
  2. Medications like GTN, amlodipine, nicorandil, ivabradine…
Chest pain in unstable angina

It’s a recent onset chest pain (<24 hours) or worsening of a previous angina. It can be triggered with low amount of physical activity or even at rest. The pain may last more than 20 minutes. It’s a gradually increasing pain with time and does not relieve by resting.

Medical emergency!!

Therefore it’s important that you seek immediate medical care. Needed medical intervention will be done by a trained medical team.

Heart attack (myocardial infarction)

Generally a heart attack is a chest pain caused 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.

Other associated symptoms may include, vomiting, sweating, palpitation, faintishness, difficulty in breathing, or even body weakness.

Heart attack is considered the most severe cardiac cause of death over the world.

Medical emergency!!

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

  1. Immediately stop what you are doing and rest/sit.
  2. Call someone for help.
  3. If you are already on angina medications take them according to your doctor’s instructions.
  4. Call an ambulance or go to the nearest hospital as soon as possible.
  5. Chew for 300 mg asprin (if available) until you reach the hospital or the ambulance unless you are allergic to aspirin or your doctor has told you not to.

Medical management of sudden severe chest pain at hospital…

  1. Immediate medical management
    • Oxygen will be given if saturation is reduced (>90%)
    • And these medications will be given immediately: Stat dose of 300 mg  Aspirin, 300mg  Clopidogrel and 40-80 mg Atorvastatin. Apart from that pain relief medications like IV morphine as well as drugs for vomiting and nausea will be given if necessary.
  1. Needed investigations/tests will be done ex. ECG, Cardiac enzyme assay ( troponin I).
  2. 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 its a heart attack (STEMI- ST elevated myocardial infarction on ECG findings/ a type of MI) thrombolysis will be done (dissolving blood clots) Subsequently, drugs like streptokinase, Tenecteplase will be used.
    • If unstable angina or NON STEMI (a type of MI), the drugs that will be used are mainly Heparin which prevents clotting of blood, but 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.

1.2 Myocarditis

Myocarditis is an inflammation, (just like an ordinary swelling and reddening of site of a wound) or an infection of the cardiac muscle. It can be caused due to many reasons like infective causes like bacterial, fungal and parasitic or connective tissue diseases like SLE, rheumatoid arthritis, PAN.

Symptoms of chest pain due to myocarditis

This is normally a chest pain  with associated symptoms given below.

    • fever
    • fatigue
    • fast heart beat
    • difficulty in breathing
Management
  1. Management of myocarditis mainly focused on treating the underlying causes mentioned above.
  2. Medication will be given depending on the cause. Corticosteroids will be given to reduce inflammation. In addition, cardiac medications like ACE inhibitors/ARB and Beta blockers will be given. If its an infection, antibiotic therapy will be done. Moreover if  fluid overload is present, diuretic therapy will be conducted.
  3. Bed resting is recommended.

1.3 Pericarditis-

Pericarditis is an 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.

Management-

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.

 

2. Lung problems causing chest pain

2.1 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.

Management –

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.

3.physiotherapy

4.neutritional supplementation

  • 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 – You can use NSAIDS. That is, non steroid anti-inflammatory drugs. 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

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