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Understanding Chest Pain:
Symptoms, Diagnosis, Treatment

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1.What is chest pain?

Chest pain is among the most common reasons for making visits to the emergency room. It varies in its intensity, duration, and location. It may be felt as 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 due to one of the many common causes that aren’t life-threatening.

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2.What are the common causes of chest pain?

The first thought that chest pain is always accompanied by a heart attack. 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

Digestion-related chest pain

Chest pain symptoms

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

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.

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3.Symptoms of chest pain

Symptoms of heart-related chest pain include

In case of heart disease, many people experience a vague discomfort that isn't quite 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

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4.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.

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  • Electrocardiogram or ECG
  • This test measures and records the electrical activity of your heart. This is done through electrodes that are attached to your skin. As injured heart muscles normally 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 cause damage to heart cells that will then allow these molecules to leak, over several hours, into your blood.

  • Chest X-ray
  • An X-ray of your chest can verify the condition of your lungs and 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.

  • Computerized tomography or CT scan
  • A CT scan is used to spot a blood clot in your lung which is otherwise known as pulmonary embolism or to make sure you're not having an aortic dissection.

Follow-up tests

Based on the results of the above preliminary tests, the following follow-up tests may be required.

  • 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 are used to produce a video image of your heart in motion.

  • Computerized 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 with the use of 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. Or a drug may be administered intravenously to stimulate the heart the way exercise does.

  • Coronary catheterization or angiogram
  • This test helps in the identification of individual arteries to the heart 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 as well as video.

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5.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, which is usually taken as a tablet under the tongue, relaxes the heart arteries. This, in turn, allows 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 that are blocking blood flow to the heart muscle.

Blood thinners: In case of a clot in an artery feeding the heart or lungs, these drugs that inhibit blood clotting may be required to prevent further clotting from occurring.

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.

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6.Surgery and other procedures

Angioplasty and stent placement

If it is a blockage in an artery feeding your heart that 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. Most often, a small wire mesh tube called a stent is placed on the outside of the balloon tip of the catheter. Upon expansion, the stent locks into place, keeping the artery open.

Bypass surgery

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

Lung reinflation

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

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7.Chest Pain FAQs: All your concerns addressed

Q. Is a person experiencing chest pain having a heart attack?

  1. According to the NCHS, only around 13% of all emergency room visits for chest pain result in a diagnosis of a serious heart-related problem. 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 gallbladder or stomach, may also result in chest pain. Another possible cause is anxiety.

Q. What is angina?

  1. 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 out into the shoulders, arms, back, neck, and even as far as the 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. What is the outlook for people with chest pain?

  1. Chest pain caused by many common conditions can be treated and resolved. These include acid reflux, asthma, anxiety attacks or related disorders. Having said that, 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 the management of your condition.

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