Chest pain - causes, symptoms, diagnosis and treatment

Chest pain is one of the most common complaints that patients seek help from a cardiologist. But they don't even suspect that cardiology may have nothing to do with it. Chest pain can be caused by completely different reasons. For example, diseases of the esophagus or respiratory system. Read more about the causes, symptoms, diagnosis and treatment of chest pain.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Causes of chest pain

Chest pain usually depends on one of the organs of the chest (heart, lungs, esophagus) or the components of the chest wall (skin, muscles or bones). Sometimes internal organs are located close to the chest, such as the gallbladder or stomach, and when their work fails, it causes chest pain. Chest pain can also be a result of pain in the neck, this is the so-called referred pain.

[ 7 ], [ 8 ]

Ischemia and angina

All organs and tissues of the body need oxygen and nutrients, which are supplied by the blood. Blood passes through a huge network of arteries throughout the body, including the vessels that supply blood to the heart muscle. These vessels, called coronary arteries, are located right on the surface of the heart muscle.

In people with coronary heart disease (CHD), the coronary arteries become clogged with fatty deposits, also called plaques. They can cause the coronary arteries to narrow, and then the blood does not receive enough oxygen, and the blood itself does not flow well through the vessels. The heart does not receive enough oxygen and begins to work intermittently. This is called coronary heart disease.

Angina is also a type of chest pain, quite dangerous. This type of heart disease is especially common during physical activity, when the heart rate increases and blood pressure rises because the heart requires more oxygen. Angina develops when the need for oxygen exceeds the amount of oxygen that the blood delivers to the heart muscle.

Heart attack (myocardial infarction)

A heart attack, or myocardial infarction (MI), occurs when blood vessels are blocked by plaques that have formed in them. Blood clots (thrombi) can partially or completely block an artery. This blood plug slows down or completely blocks the flow of blood to the area of the heart muscle. And then the person feels chest pain. If the pain lasts more than 15 minutes, the muscles can be damaged and tissue death occurs - a heart attack. During a heart attack, the patient may feel discomfort and pain that is similar to the pain of ischemia. A heart attack can occur after a long period of angina.

Other cardiovascular diseases

Some cardiovascular conditions that do not involve blood flow in the coronary arteries can cause chest pain.

Some people suffer from classic angina pain. This is called variant angina, which can be caused by a temporary spasm of the coronary arteries. These arteries are usually not affected by cholesterol plaques, so they are not narrowed, and doctors do not diagnose the arteries as blocked. But with variant angina, a partial blockage of the artery can occur due to a spasm in one area.

Pericarditis, or inflammation of the membrane around the heart, can also cause chest pain that gets worse with deep breathing. The pain may be relieved by sitting up or leaning forward. When listening to the heart, the doctor hears unusual, uncharacteristic heartbeat sounds. This is the noise of the pericardial folds. Problems with the heart (pericardium) are confirmed by an electrocardiogram (ECG).

Inflammation of the heart muscle, called myocarditis, can also cause chest pain that is similar to ischemic pain. Myocarditis is often caused by a viral infection.

Another cause of classic angina pain in people with normal coronary arteries is "Syndrome X," which is more common in women. People with this condition may not even know the cause of their chest pain.

Problems with the heart valves or the heart muscle (called hypertrophic cardiomyopathy) can also sometimes cause typical chest pains, such as angina. People diagnosed with mitral valve prolapse and aortic stenosis, for example, may often complain of chest pain.

A rare but serious cause of chest pain is aortic dissection (rupture). The aorta is the main artery in the body. It is made up of several layers of muscle cells, similar to the layers surrounding an onion. Sometimes these layers rupture, causing a person to bleed outside the circulatory system, meaning blood spreads throughout the body. This is a very serious condition that can only be treated with vascular surgery. Chest pain due to aortic dissection is usually very severe, it occurs very suddenly, radiating to the back or between the shoulder blades.

Chest pain can also spread to the skin, muscles, bones, tendons, soft tissues and cartilages of the chest, so even with palpation a person feels severe pain. Trauma, including recent surgery, can lead to severe chest pain (it is felt more in the chest wall).

Chest pain due to esophageal diseases

The esophagus is a tube that connects the oral cavity, throat and stomach. Since the esophagus and heart are served by the same nerves, in some cases, chest pain due to the esophagus can be confused with cardiac ischemia. In some patients, chest pain due to esophageal diseases causes its spasm and becomes weaker after taking nitroglycerin.

A number of medical conditions can cause esophageal pain, including gastroesophageal reflux disease, also known as heartburn, which is caused by acid from the stomach flowing back into the esophagus. This pain can be uncomfortable or very painful for a person.

Chest pains can be caused by spasms of the esophagus due to a disorder of its motility - the muscles around the esophagus do not move correctly, causing chest pain. Causes of chest pain can be esophagitis - inflammation of the esophagus, sometimes it occurs due to medications.

Gastrointestinal tract

Gastrointestinal diseases increase the number of problems associated with chest pain, which begins and then spreads throughout the chest. Diseases that cause chest pain include ulcers, gallbladder disease, pancreatitis, irritable bowel syndrome.

Chest pain due to respiratory diseases

The lungs cause a number of problems that cause chest pain. Many respiratory diseases cause pain that gets worse with deep breathing.

Pulmonary embolism is a blood clot in the vessels of the lungs. It almost always affects people at high risk of complications due to recent surgery, those who are on bed rest for a long time, pulmonary embolism can occur in pregnant women or patients after recent pelvic surgery. Chest pain with pulmonary embolism occurs suddenly, it is accompanied by shortness of breath and may worsen with deep breaths.

Pneumonia - infection and inflammation of the lungs can cause chest pain, cough and fever.

Pleurisy is an inflammation of the tissues surrounding the lungs. Pleurisy can occur due to a viral disease or as a complication after an injury. Pleurisy can also be provoked by such diseases as pneumonia, pulmonary embolism. Pleurisy causes chest pain.

Pneumothorax is a collapsed lung, causing an air pocket to form between the chest wall and the lungs. Pneumothorax causes chest pain, sometimes very severe and unbearable.

Psychological Causes of Chest Pain

Panic disorder or depression can make a person feel chest pain. Severe chest pain associated with panic attacks of fear or anxiety can occur in a person with disorders of the unequal system. These changes can be diagnosed on an electrocardiogram (ECG).

Chest pain can occur when the nerves in the chest wall become inflamed. The pain can radiate to the tissues around the lungs, the diaphragm, or the lining of the abdomen. A herniated disc or arthritis in the cervical spine can cause persistent, complex chest pain.

Symptoms of chest pain in heart disease

Chest pain caused by angina or pain caused by a myocardial infarction may be similar. They differ in duration and severity. If the pain lasts no more than 15 minutes, it is angina, and if it lasts more than half an hour, it is a heart attack. With a heart attack, the pain is stronger and more acute. Depending on the cause, chest pain can be sharp, dull, burning, and it can be localized in one or more areas (in the middle of the chest, upper chest, back, arms, jaw, neck, or the entire chest area). Heart pain may become weaker or worsen after physical activity or even during rest. There may be other accompanying symptoms (sweating, nausea, rapid heartbeat, shortness of breath).

Ischemic chest pain is usually not localized to a specific location, but is felt throughout the chest. Heart pain is often localized in the center of the chest or upper abdomen.

If the pain is felt only on the right or left side, and not in the center of the chest, it is unlikely to be caused by coronary artery disease.

Radiating chest pain is heart pain that radiates to other areas of the upper body, not just the chest. These areas are the neck, throat, lower jaw, teeth (chest pain can radiate to the teeth), and also the shoulders and arms. Sometimes chest pain can be felt in the wrists, fingers, or between the shoulder blades.

Unlike non-cardiac pain, heart pain can start suddenly and get worse at the very beginning. It is often associated with physical exertion. Non-cardiac pain, unlike cardiac pain, can last only a few seconds or persist for several hours. The pain can become weaker when a person takes nitroglycerin or does not go away even after taking it. Then it is a very serious symptom. Pain that persists for several days or weeks most likely indicates angina or a heart attack.

Muscle spasms or spasms of the esophagus that cause chest pain may be relieved by taking nitroglycerin. If eating or taking antacids relieves chest pain, it is likely caused by a problem with the esophagus or stomach.

Ischemic pain is usually not aggravated by deep breathing or pressing on the painful area where the person feels discomfort. Ischemic pain is usually not dependent on body position, although some patients with ischemia feel relief when sitting down, especially when leaning forward.

Associated symptoms of cardiovascular diseases causing chest pain

• Dyspnea
• Nausea, vomiting, belching
• Sweating
• Cold, clammy goose bumps
• Frequent and rapid pulse
• Rapid heartbeat
• Fatigue
• Dizziness
• Fainting
• Indigestion
• Abdominal discomfort
• Tingling in the arm or shoulder (usually on the left)

[ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ]

Diagnosis of chest pain

Many conditions and diseases can cause chest pain, and they are diagnosed in different ways.

Basically, the diagnostics first use the palpation method and the doctor's questioning. In some diseases that cause chest pain, palpation can clearly show the cause. For example, in angina pectoris, when pressing on the chest area, the chest hurts even more.

An electrocardiogram, or ECG, shows how electrical waves pass through different parts of the heart muscle. People with ischemic chest pain have heart muscle changes that are easily seen on an ECG.

Blood tests - may be used to analyze enzymes in the heart muscle. During a heart attack, these enzymes may move from the heart into the blood. Cardiac enzyme tests found in the blood may indicate the possibility of a myocardial infarction.

Stress test – the patient is observed while he or she is walking or running on a treadmill. This method is very indicative in diagnosing ischemia. During active running or walking, cardiac activity is monitored on an ECG. This way, the doctor can recognize the symptoms of ischemia. Echocardiography can also be used to diagnose cardiovascular diseases.

Cardiac catheterization – Also known as coronary angiography, this procedure uses a small catheter inserted into the coronary arteries and a special dye to show the outline of the heart. An arteriogram is recommended for people at high risk of coronary artery disease and blocked arteries. The results of an arteriogram can help determine the best treatment.

Data Interpretation – with this diagnostic method, the doctor will be able to synthesize all the factors described above to determine the cause of chest pain. Even if there is evidence of coronary heart disease, the pain can also be caused by other diseases. Many of them can imitate ischemic chest pain. Statistics show that in most cases, chest pain that causes a person to call an ambulance is not caused by angina or myocardial infarction.

[ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ]

Treatment of chest pain

Using nitroglycerin. If you have coronary heart disease, your doctor may prescribe nitroglycerin. Nitroglycerin is placed under the tongue as soon as chest pain occurs. If your mouth is dry at this time, you can drink some water. This will help the tablet dissolve under the tongue. You need to sit down (nitroglycerin can cause dizziness. You should not swallow nitroglycerin - this would be wrong. After taking one nitroglycerin tablet, wait five minutes (check this time on your watch). If the chest pain does not go away after five minutes, call an ambulance immediately and take a second tablet until the doctors arrive.

If chest pain is caused by diseases of the respiratory system, antibiotics are used - for example, in the treatment of pneumonia.

If chest pain is caused by gastrointestinal diseases, folk remedies are used, for example, fresh potato juice for ulcers or painkillers.

One of the ways to treat chest pain can also be to change your daily routine: increasing or, conversely, decreasing physical activity.

Chest pain is a serious symptom, so you should see a doctor if this pain does not go away for a long time.