What Is Chest Pain?

Chest pain is among the most common reasons for visits to the emergency room. It varies in intensity, duration, and location. It may be a sharp, stabbing pain or a dull ache. While it may be a sign of a serious heart-related problem, it may also be caused by one of the many common causes that aren’t life-threatening.

What Are The Common Causes Of Chest Pain?

The first thought is that a heart attack always accompanies chest pain. However, according to the National Center for Health Studies (NCHS), only around 13% of all emergency room visits for chest pain result in a diagnosis of a serious heart-related problem, collapsed lung or a clot in your lung.

Heart-related chest pain

Heart-related chest pain may be caused by:

the blockage of blood flow to the heart, i.e. a heart attack
Blockages in blood vessels leading to the heart, i.e. Angina
Inflammation of the heart around the sac, i.e. pericarditis
Inflammation of the heart muscle, i.e. myocarditis
a disease of the heart muscle, i.e. cardiomyopathy
a tear in the aorta, i.e. an aortic dissection

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Digestion-related chest pain

The gastrointestinal causes of chest pain are:

gallstones
acid reflux or heartburn
swallowing problems related to esophageal disorders
inflammation of the gallbladder or pancreas

Lung-related chest pain

The lung-related causes of chest pain are:

bronchospasms that commonly occur in people who have asthma and related disorders such as chronic obstructive pulmonary disease (COPD).
pneumonia
viral bronchitis
pneumothorax
a blood clot or pulmonary embolism

Rib- or fracture-related chest pain

The following, too, can cause chest pain.

Bruised or broken ribs
Compression fractures causing pressure on a nerve

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Anxiety-related chest pain

Periods of intense fear accompanied by chest pain, a rapid heartbeat, shortness of breath, profuse sweating, rapid breathing, nausea, dizziness and a fear of dying indicate that you may be experiencing a panic attack. Panic attacks can also cause chest pain.

Symptoms Of Chest Pain

Symptoms of heart-related chest pain include

In the case of heart disease, many people experience a vague discomfort that isn't reasonably identified as pain. In general, chest discomfort related to a heart attack or other heart problems may be associated with or described as one or more of the following:

Pressure, fullness, tightness, or burning in the 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, subsides and returns, or varies in intensity
Shortness of breath
Cold sweats
Dizziness or weakness
Nausea or vomiting

Other symptoms

Symptoms of chest pain that isn’t heart-related include:

difficulty swallowing
a sour or acidic taste in your mouth
pain that is felt only after you swallow or eat
pain that lessens or heightens depending on your body position
pain that worsens when you breathe deeply or cough
pain accompanied by a rash
fever
chills
aches
back pain that radiates to the front of your chest
runny nose
cough
anxiety or panic
hyperventilation

Diagnosis Of Chest Pain: Essential Tests

Since a heart attack poses the highest threat to your life, that will be the test that will be run first in the emergency room. Life-threatening lung conditions, such as a clot or a collapsed lung - will also be subsequently eliminated.

Electrocardiogram or ECG

This test measures and records the electrical activity of your heart through electrodes attached to your skin. As injured heart muscles usually do not conduct electrical impulses, the ECG may show that you have had or are having a heart attack.

Blood tests

Blood tests are required to check for a rise in the levels of proteins or enzymes found in the heart muscle. A heart attack may damage heart cells, allowing these molecules to leak into the blood over several hours.

Chest X-ray

An X-ray of your chest can verify the condition of your lungs, the size and shape of your heart, and all the major blood vessels. It can also reveal lung problems such as pneumonia or a collapsed lung.

Computerised tomography or CT scan

A CT scan is used to spot a blood clot in your lung, otherwise known as a pulmonary embolism, or to ensure you're not having an aortic dissection.

Also Read - Chest Pain in Children

Follow-up tests

The following follow-up tests may be required based on the results of the above preliminary tests.

Echocardiogram

During an echocardiogram, a small device may be passed down your throat to obtain better views of different parts of your heart. Here, sound waves produce a video image of your heart in motion.

Computerised tomography or CT scan

CT scans are of different types. They are used to check for blockages in your heart arteries. A CT coronary angiogram can be done using a dye to check the heart and lung arteries for blockages and other issues.

Stress tests

Stress tests record how your blood vessels and heart respond to exertion. This information may indicate if your chest pain is related to problems with the heart. Stress tests are of many kinds. A common one involves being asked to walk on a treadmill or pedal a stationary bike while an ECG machine is connected to you. A drug may also be administered intravenously to stimulate the heart as exercise does.

Coronary catheterisation or angiogram

This test helps identify individual heart arteries that may have become narrowed or blocked. A dye is injected into the arteries of your heart through a thin, long tube called a catheter. The catheter enters your body through an artery either in your wrist or your groin. As the dye wells up in your arteries, the arteries become visible on X-rays and video.

Treatment Of Chest Pain

Medications

Drugs may be used to treat some of the most common causes of chest pain. These include:

Artery relaxers: Nitroglycerin, usually taken as a tablet under the tongue, relaxes the heart arteries, allowing blood to flow more easily through the narrow spaces. Some medicines for blood pressure also relax and widen blood vessels.
Aspirin: If there is reason to believe your chest pain is heart-related, you'll likely be prescribed aspirin.
Thrombolytic drugs: These clot-busting drugs are reserved for heart attacks. They work to dissolve clots, blocking blood flow to the heart muscle.
Blood thinners: If a clot forms in an artery feeding the heart or lungs, drugs that inhibit blood clotting may be required to prevent further clotting.
Acid-suppressing medications: If the chest pain is caused by the splashing of stomach acid into the oesophagus, these medications that reduce the quantity of acid in the stomach will be needed.
Antidepressants: In case of panic attacks, antidepressants may be recommended to aid in the control of your symptoms. Psychological care, such as cognitive behavioural therapy (CBT), may also be prescribed.

Surgery And Other Procedures

Angioplasty and stent placement

If a blockage in an artery feeding your heart is causing your chest pain, a catheter with a balloon at the end can be inserted into a large blood vessel in your groin and threaded up to the blockage. The balloon tip will be inflated to widen the artery, then deflated, and the catheter removed. A small wire mesh tube called a stent is often placed on the outside of the balloon tip of the catheter. Upon expansion, the stent locks into place, keeping the artery open.

Bypass surgery

In this procedure, a blood vessel from another body part is grafted to create an alternative route for blood to bypass the blocked artery.

Lung reinflation

In case of a collapsed lung, a tube can be inserted into the chest to reinflate it.

Chest Pain Faqs: All Your Concerns Addressed

Q. Is a person experiencing chest pain having a heart attack?
A. According to the NCHS, only around 13% of all chest pain emergency room visits result in a severe heart-related problem diagnosis. Half of all cases of chest pain are diagnosed non-cardiac, i.e., not related to the heart, and include primarily gastroesophageal disorders, i.e. disorders of the digestive tract, such as gastroesophageal reflux disease or GERD. Chest pain may also arise from issues in the organs present in the chest cavity or even issues with the chest wall or other parts of the chest. Problems with organs close to the chest, such as the stomach, may also result in chest pain. Another possible cause is anxiety.

Q. What is Angina?
A. Angina is often likened to producing a squeezing sensation, tightness, or pressure in the chest region of the body. The discomfort or pain may also radiate into the shoulders, arms, back, neck, and jaw. In women, chest pain may be accompanied by nausea, vomiting, shortness of breath, abdominal pain, etc. While Angina is not a disease in itself, it is a symptom of underlying heart disease.

Q. How can one differentiate between chest pain and angina?
A. Chest pain is a general term for pain in the chest region that can arise for multiple reasons. However, angina is a specific type of chest pain that arises due to heart-related problems.

Q. How can you determine if your chest pain is severe?
A. To understand if your chest pain is a severe concern, you must keep a check on the following symptoms:

A sudden feeling of tightness or squeezing sensation within the chest
Nausea or dizziness
Fatigue
Breathing issues
Too much sweating

Note: You must take chest pains seriously if the patient is aged, obese, suffers from diabetes, is hypertensive, or has a family history of heart issues.

Q. What is stable angina?
A. Stable angina occurs when your heart works harder due to exertion or mental or emotional stress. The pain usually goes away with rest because your heart no longer needs as much oxygen.

Q. What is unstable angina?
A. Unstable angina occurs unexpectedly due to coronary arteries narrowed by plaque (fatty buildups), which reduces blood flow to the heart. Unstable angina may also occur when a clot partly or completely blocks your heart artery for a short period; it either breaks up on its own or with medication. If the clot persists, a heart attack may occur. Inflammation, infection, and secondary causes can also lead to unstable Angina.

Q. What other conditions might cause chest pain?
A. Various conditions, including gastrointestinal disorders such as gallbladder disease, peptic ulcer, oesophagal muscle spasm, or acid reflux, may cause chest pain. It may also signal another severe heart or lung issue, such as a tear in the wall of the aorta or a blood clot in the lung.

Q. What can you do if you are diagnosed with angina?
A. While angina pain may come and go, it’s a sign that you’re suffering from heart disease that must be treated. To cure it, your healthcare provider can give you nitroglycerin to relieve your discomfort. It’s available in multiple forms, such as tablets, sprays, capsule skin patches, or ointments.

In case you experience severe chest pain lasting more than five minutes or are accompanied by other heart attack symptoms like – shortness of breath, nausea, weakness, etc., you must call your nearest hospital for immediate assistance.

Q. What precautions must I take to minimise the chances of Angina?
A. To address your primary health concerns and minimize the chances of suffering from Angina, you must take into consideration the following steps:

Avoid alcohol consumption and smoking.
Change your eating habits and intake more of healthy food items that are low in fat and salt. Sources of protein like chicken, fish, and soy.
Keep a check on your blood pressure and cholesterol levels
Exercise regularly but avoid extreme temperatures and performing strenuous activities
Keep yourself relaxed and calm, and manage your stress levels to avoid triggering anxiety or panic attacks

Q. What is the outlook for people with chest pain?
A. Chest pain caused by many common conditions can be treated and resolved. These include acid reflux, asthma, anxiety attacks, or related disorders. Chest pain can also be a symptom of certain life-threatening conditions. It is, therefore, not just important but crucial to seek immediate medical attention in case you think you may be experiencing a heart attack or another severe heart problem. Once a diagnosis is made, treatments will be prescribed to aid you in managing your condition.

Q. How long do I need to rest after encountering a heart attack?
A. Rest is important after a heart attack, but it's just as important to participate in recreation and social events and begin making physical activity a part of your daily life. In many cases, doctors will recommend that survivors get more physical activity than they did before their heart attack.

A good night's rest is especially important for heart attack patients. If you feel tired during the day, take a nap or rest briefly. Heart patients should rest before they get too tired. Your doctor will tell you what's best for your specific situation, but most heart attack patients find they have plenty of energy for both work and leisure activities.