What Causes Chest Pain?

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What is chest pain?

Chest pain is uneasiness and/or sensitivity in/around the chest. As a rule, causes of chest pain are divided into heart-related chest pain and non-cardiac. In case of acute heart pain, a person should be immediately examined by emergency medical services as certain causes are life-threatening.

Depending on the cause, patients describe chest pain as harsh, blunt, burning, nagging, excruciating, a tight, pressing, or breaking feeling. It can spread to the back, neck, face and hands. Pain associated with cardiovascular system problems manifest with breathlessness, heavy sweats, vertigo, fatigue, and sickness.

Extracardiac disorders are present with a musty taste or a sense of food return, a difficulty swallowing and anxious breathing. Complaints may arise when the body position changes.

What causes chest pain?

Cardiovascular associated problems:

  • Arterial lipidosis and angina. Plaques lead to constant narrowing of blood vessels and limit the heart’s perfusion.
  • Dissecting aneurysm.  Blood runs between the aortic layers, causing the walls to move apart, and the chest hurts.
  • Heart attack. Inadequate perfusion of oxygen and blood causes a diffuse sharp pain in the chest.
  • Pericarditis. The inflamed heart protective sac provokes sharp chest pains.
  • Valvular defects.

Digestive causes:

  • Epigastric burning. The state, when the gastric acid reaches the esophagus.
  • Dysfunction of the esophagus.
  • Pancreas or gallbladder disruptions. Stones or inflammatory process lead to abdominal pain that spreads to the thorax.
  • Perforation of internal organs. A rupture in the stomach or intestinal walls allows air to enter the abdominal cavity and irritate the diaphragm that causes chest pain.

Musculoskeletal disorders:

  • Tietze’s syndrome. The inflamed cartilage connection of ribs and sternum provoke agonizing movement.
  • Sore or stretched muscles.
  • Fractured ribs.
  • Posture disorders.
  • Hernia of the intervertebral disk.
  • Osteochondrosis.

Lung problems:

  • Pulmonary embolism. If a blood clot is stuck in pulmonary vessels it keeps the blood in the lung tissue and causes acute discomfort.
  • Pleuritis. The inflammation of lung membrane causes chest pains that worsen while inhaling or coughing.
  • Pneumothorax. The condition happens when air passes the lung. The condition begins suddenly and continues for hours.

Other causes:

  • Panic attacks.
  • Herpes zoster.
  • Benign and malignant neoplasms of the mammary gland.
  • Traumas.
  • Widespread vasculitis.
  • Compression by a tight bra.

How is chest pain diagnosed?

To find the underlying cause of chest pains, the doctor must take into consideration the circumstances and examination details. Constant chest pain, which is not eased by nitrates, indicates spine injuries or neurological disorders.

Blood pressure, pulse and respiratory rates, temperature, oxygen saturation and listening for heart and lung sounds are the primary test. Elevated levels of serum troponin and D-dimer indicate heart muscle damage. Basic metabolic profile is helpful in emergency estimation.

Instrumental examinations include:

  • ECG;
  • Chest X-ray;
  • CT of thorax;
  • Gastrointestinal examination;
  • X-ray of spine, shoulder joints, ribs;
  • Cardiac magnetic resonance imaging;
  • Isotope scan and CTPA scan;
  • Endoscopy;
  • Echocardiography.

The correct preliminary evaluation of the pain syndrome determines the healing work and the prognosis. The most essential for the differential diagnostics of chest pains is the examination of the endurance, the hardness of the pain, analysis of provoking factors, the circumstances of pain relief, localization and other specific features. It must be remembered that modern laboratory resources and instrumental methods of investigation should be used to confirm the diagnosis.

How to get rid of chest pain?

Sometimes treatment can be started even without an exact diagnosis. Treatment should be directed for a specific reason. In the case of acute life-threatening conditions, the patient should urgently be hospitalized.

When the chest pains are caused by strained muscles or a fractured rib it is recommended to rest and take a break from any work. Ice relieves pain and swelling. If the swelling is gone, the warm compress is preferable. Gentle stretching and massage reduce the complaints.

Medications used to treat the most common chest pain causes include:

  • Artery relaxers. Nitroglycerin and certain antihypertensive agents widen heart arteries to restore the perfusion.
  • Aspirin reduces blood clotting to help blood run through a narrowed vessel.
  • Blood thinners prevent the formation of clots.
  • Acid-suppressing medications are suggested to reduce the amount of acid in the stomach.
  • Antidepressants prevent panic attacks and relieve suffering. Psychological therapy might also be helpful.

Coronary arteries are kept open with angioplasty with stents to perform coronary bypass surgery. Surgical intervention is needed in case of a tumor, collapsed lung or rib fracture and injuries, and to restore an aortic dissection.

How to prevent chest pain?

Hints to prevent cardiac and extracardiac chest pain:

  • avoid smoking and drinking alcohol;
  • prefer balanced, nutritious meals;
  • limit the amount of sodium, added sugars, solid fats, and refined grains;
  • maintain a healthy weight;
  • reduce stress;
  • monitor blood pressure;
  • follow the recommended activity program.

References:

  1. Authors/Task Force Members, et al. “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).” European heart journal 29.19 (2008): 2388-2442.
  2. Hunt, Sharon A., et al. “ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure) Developed in Collaboration with the International Society for Heart and Lung Transplantation Endorsed by the Heart Failure Society of America1.” The Journal of Heart and Lung Transplantation 21.2 (2002): 189-203.
  3. Authors/Task Force Members, et al. “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.” European heart journal 33.14 (2012): 1787-1847.

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