Chest Pain

Overview

Chest pain is when you feel discomfort or pain in the center of your chest. This feeling can be different for everyone, like heavy pressure, sharp pain in the chest, burning sensation, or a mild ache. The pain might stay in your chest or spread to your shoulders, arms (especially the left one), jaw, neck, or back. The kind of pain and where you feel it can depend on what’s causing it.

Types of Sharp Chest Pain

There are different types of chest pain caused by various reasons:

• Musculoskeletal Chest Pain: Feels sharp and comes from muscles, ribs, or chest joints. It can get worse with movement or deep breathing.
• Gastrointestinal Chest Pain: Linked to digestive issues like acid reflux or gastritis. It’s often a burning sensation in the upper abdomen that can spread to the chest.
• Cardiac Chest Pain: Caused by heart problems like angina or heart attack. Described as squeezing or pressure in the center or left side of the chest.
• Pulmonary Chest Pain: Lung-related issues such as pneumonia or pleurisy. The pain is often sharp and gets worse with breathing or coughing.
• Psychological Chest Pain: Connected to stress, anxiety, or panic attacks. Feels like tightness or heaviness in the chest, often with rapid heartbeat and shortness of breath. Sometimes, you don’t usually cause intense pain but it can result in recurring discomfort.

What Causes Chest Pain?

Chest pain can come from many different reasons, ranging from mild issues to serious emergencies. Here are some common chest pain causes:

Severe Chest Pain and Heart Problems

• Angina: Chest discomfort from less blood flow to the heart muscle, often due to heart artery problems.
• Heart Attack: Sudden chest pressure and heart pain caused by a blocked heart artery, which can hurt the heart muscle.
• Heart Inflammation: Swelling in the heart muscle, usually because of viral infections.
• Pericarditis: Inflammation around the heart that leads to sharp chest cramps.
• Coronary Aortic Dissection: A tear in the main artery from the heart, causing severe, sharp chest pain.

Lung Issues 

Lung related causes are as under:

• Pneumonia: Lung infection that causes chest pain along with coughing, fever, and trouble breathing.
• Pulmonary Embolism: Blockage in a lung artery by a blood clot, causing sudden chest pain and breathing problems. 
• Pleurisy: Inflammation around the lungs, making chest pain worse with deep breathing or coughing.
• Collapsed Lung (Pneumothorax): Lung collapse causing sharp chest pain and difficulty breathing. 

Stomach and Digestive Problems

• Acid Reflux (GERD): Acid moving back up the food pipe, causing burning chest pain (heartburn). 
• Esophageal Spasm: Sudden, intense, and constant chest pain from abnormal muscle contractions in the food pipe. 
• Peptic Ulcer Disease: Stomach or food pipe ulcers that hurt the chest, especially after eating. 

Muscle and Bone Issues

• Costochondritis: Inflammation of cartilage between ribs and breastbone, causing chest pain that gets worse with movement.
• Muscle Strain: Chest muscle or ligament injury causing sharp or dull chest pain when moving.

Mental Health

• Anxiety and Panic Attack: Feeling scared or anxious can lead to upper chest pain, fast heartbeats, and shortness of breath.
• Depression: Sometimes, chest pain is linked to feelings of sadness or depression.

If you have unexplained chest pain, the only way to confirm its cause is to have immediate medical help.

How can a blood clot cause chest pain?

A Blood clot can cause chest pain primarily when it obstructs blood flow in the heart or lungs. Two key conditions related to this are:

1. Pulmonary Embolism (PE): A blood clot that travels to the lungs and blocks one of the pulmonary arteries can cause sudden, sharp chest pain, often accompanied by shortness of breath, rapid heartbeat, and sometimes coughing up blood. The pain can worsen with deep breaths or coughing.
2. Heart Attack (Myocardial Infarction): A blood clot that forms in one of the coronary arteries can block blood flow to a part of the heart muscle, causing chest pain or discomfort (often described as pressure, tightness, or squeezing). This chest pain may radiate to the arms, neck, jaw, or back and some associated symptoms like shortness of breath, sweating, and nausea.

What is an Arota and Aortic Dissection?

The aorta is the body’s largest artery, starting from the heart and running down to the abdomen, where it splits into smaller arteries. Its job is to carry oxygen-rich blood from the heart to the rest of the body.

Aortic dissection is a dangerous condition where a tear occurs in the inner layer of the aorta. A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body ( aortic dissection ) causes sudden, severe pain in the chest and upper back.

Symptoms

Chest pain symptoms can be different depending on whether they come from the heart (cardiac) or other parts of the body (non-cardiac). Here’s what you might experience with each:

Heart-related (Cardiac) Chest Pain

Angina Pectoris

   – Feels like pressure or discomfort in the center of the chest.

   – Pain might spread to the neck, jaw, shoulders, or left arm.

   – Often triggered by physical activity or stress.

   – Gets better with rest or medication like nitroglycerin.

If you’re at risk for heart disease or coronary artery disease, you’re also at risk for angina.

Heart Attack (Myocardial Infarction)

   – Sudden intense pain or tightness in the chest.

   – Pain can go to the arms, back, neck, jaw, or stomach.

   – Shortness of breath.

   – Sweating, nausea, vomiting.

   – Feeling like something bad is about to happen.

   – Irregular heartbeat.

Non-Heart-related (Non-Cardiac) Chest Pain

Gastroesophageal Reflux Disease (GERD)

   – Burning feeling in the chest (heartburn) and upper abdominal pain, especially after eating or lying down.

   – Sour taste in the mouth.

   – Pain gets worse when lying down or bending over.

Musculoskeletal Causes (like Costochondritis and muscle Strain)

   – Sharp or stabbing chest pain that hurts more when moving or touching.

   – Pain stays in the chest wall or rib cage.

   – Pain can be felt when pressing on the sore area.

Pulmonary Causes (like Pneumonia, Pleurisy, Pulmonary Embolism)

   – Sharp or stabbing chest pain that gets worse with breathing or coughing.

   – Shortness of breath.

   – Coughing up blood (if it’s pneumonia or pulmonary embolism).

   – Fever and chills (for infections).

Psychological Causes (like Anxiety and panic Attacks)

   – Chest feels tight or uncomfortable.

   – Feeling like you can’t breathe well.

   – Sudden feeling of fear and heart racing or pounding.

   – Sweating, trembling, shaking, or rapid breathing

   – Fear of losing control or dying.

When is chest pain serious? 

Chest pain needs urgent medical attention if it’s severe, persistent, or comes with difficulty breathing, dizziness, sweating, or pain spreading to the arm, jaw, neck, or back. People with heart disease, high blood pressure, diabetes, or other risk factors should also seek prompt evaluation to rule out chronic chest pain conditions like a heart attack or pulmonary embolism.

What is Hiatal Hernia?

A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm into the chest cavity. The diaphragm is the muscle that separates the abdomen from the chest. Normally, the esophagus (food pipe) passes through an opening (hiatus) in the diaphragm and connects to the stomach in the abdomen.

There are two main types of hiatal hernias:

1. Sliding Hiatal Hernia: This is the most common type where the junction between the esophagus and stomach slides up into the chest cavity.
2. Paraesophageal Hiatal Hernia: In this less common type, the stomach bulges up through the hiatus next to the esophagus, but the junction between the esophagus and stomach remains in its normal position.

Hiatal hernias can cause symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation of food or liquids. Treatment options vary depending on the severity of symptoms but may include lifestyle changes, medications to reduce stomach acid, or in severe cases, surgery to repair the hernia.

Diagnosis

Chest pain diagnosis involves a thorough evaluation that can include several tests. The approach used depends on the patient’s history, symptoms, and suspected problems. Here are common ways cardiologists diagnose chest pain:

Medical History and Exam

• The cardiologist asks about the pain—how it feels and how long it lasts.
• They’ll look at past health, risk factors (like smoking or high blood pressure), family heart history, and recent activities.

Electrocardiogram (ECG or EKG)

This test checks the heart’s electrical activity to find problems like irregular heartbeats or signs of a heart attack.

Blood Tests

• Measures heart enzymes to see if there’s heart muscle damage (like in a heart attack).
• Other blood tests check for inflammation, infection, or electrolyte imbalances.

Chest X-ray

Helps spot lung issues like pneumonia, collapsed lung, or fluid around the lungs.

Echocardiogram

 Uses ultrasound to see how the heart is working and find any problems with its valves or structure.

Stress Testing

Check how the heart responds to stress (like exercise) to diagnose heart disease risk.

CT Scan or MRI

Provides detailed heart images to find problems like blocked arteries or heart defects.

Esophageal Tests

Check for issues like acid reflux that can cause chest pain.

Lung Function Tests

Measures lung health to diagnose asthma or COPD.

Cardiac Catheterization

Invasive tests to check for blocked heart arteries using a small tube inserted into the blood vessels.

Chest Pain Treatment

The treatment for chest pain depends on what’s causing it. Chest pain can come from heart problems, lung issues, stomach troubles, muscle strains, anxiety, or other health issues. Here’s how chest pain is typically treated based on different causes:

Heart-Related Chest Pain

Angina Pectoris

• Eating healthy, exercising regularly, quitting smoking, and managing stress.
• Nitroglycerin: Helps relieve angina episodes.
• Beta-blockers, calcium channel blockers, or nitrates: Used to prevent and manage angina attacks by improving blood flow to the heart.
• Angioplasty with stenting or heart bypass surgery if severe to restore blood flow to the heart.

Heart Attack (Myocardial Infarction)  

• Clot-busting drugs or antiplatelet medications to dissolve or prevent blood clots
• Beta-blockers, ACE inhibitors, or statins stabilize the heart and reduce future risks.
• Emergency angioplasty or heart surgery to restore blood flow.
• Supervised exercise and education for recovery and prevention.

Non-Heart-Related Chest Pain

Gastroesophageal Reflux Disease (GERD)

• Avoiding trigger foods, eating smaller meals, and not lying down after eating.
• Antacids, H2 blockers, or proton pump inhibitors to reduce stomach acid.
• Surgery in severe cases.

Musculoskeletal Causes (like Costochondritis and muscle Strain)

• Pain relievers like NSAIDs or acetaminophen.
• Stretching exercises and posture improvement.
• Rest and avoid activities that cause severe pain.

Pulmonary Causes (like Pneumonia, Pleurisy, Pulmonary Embolism)

• Antibiotics for bacterial pneumonia.
• Blood thinners for pulmonary embolism.
• Specific treatments for lung conditions like asthma.

Anxiety or Panic Attacks

• Therapy like CBT.
• Anti-anxiety meds or antidepressants.
• Stress reduction techniques like deep breathing and relaxation exercises.

When To See A Doctor

If you experience sudden or severe chest pain, along with symptoms like shortness of breath, sweating, nausea, or pain spreading to your arms, jaw, or back, visit a cardiologist right away. This is especially true if you have a history of heart disease, high blood pressure, diabetes, or other risk factors. Your health is important, so don’t ignore concerning chest pain symptoms. Without treatment, it can lead to life-threatening complications.

Disclaimer

This information is intended for educational purposes only and should not be considered a substitute for professional medical advice. If you have concerns about chest pain or any other medical condition, please see a doctor for an accurate diagnosis and personalized treatment suggestions.