Chest pain is one of the most common causes for visits to the hospital emergency centre. Most people with chest pain are often worried that it is related to their heart but there is a wide variety of conditions that can cause this common complaint.
This gives a classic pain that is located at the centre of the chest. It usually feels as though your chest is being crushed. Most people describe it as the worst chest pain that they have ever experienced. The pain may spread to the neck or arm. There may be associated sweating, difficulty breathing, nausea, palpitations and even dizziness. Risk factors for developing a heart attack include high blood pressure, diabetes, smoking, obesity and high levels of ‘bad’ cholesterol. Usually, a heart attack is caused by blockage of the blood vessels supplying the heart. The blockage is due to clogging of these blood vessels with fatty deposits.
This is pain caused by poor blood supply to the heart – usually, there is a partially blocked blood vessel supplying the heart muscle. The pain is similar to that of a heart attack but milder. In some people, the pain comes only when one exerts themselves e.g. during sexual intercourse, walking up stairs, exercising etc. This is referred to as ‘stable angina’. In some cases, the pain may come even at rest. This is referred to as ‘unstable angina’.
Lung infections may present with chest pain. Usually, this pain is worse on coughing or on taking deep breaths. In addition to cough, lung infections may also cause rapid or difficult breathing and fever. Lung infections include pneumonia (which may be bacterial, viral or fungal), bronchitis or tuberculosis. Night sweats and weight loss may accompany tuberculosis.
Rarely, the layer surrounding the heart may become inflamed. This is referred to as pericarditis. Pain caused by pericarditis is often sharp or stabbing in nature, is worse when you lie down and is relieved when one leans forward. In addition, the muscles of the heart may become inflamed in a condition referred to as myocarditis. This can also present with chest pain.
Heartburn and Reflux
Heartburn typically presents with a burning sensation that is located in the upper part of the belly and may sometimes spread to the middle of the chest. Unlike angina or heart attacks, this pain does not move to the arm or neck. In reflux, there may be an intermittent bitter taste in the mouth that may be more noticeable in the morning. In addition, there may be recurrent sore throat, change in the way your voice sounds (becomes hoarse) and bad breath. Chest pain caused by heartburn is usually not accompanied by cough or fever. Small babies with severe reflux can sometimes have food content leave their stomach and get into their lungs resulting in pneumonia. If you have persistent heartburn, you must be evaluated for possible ulcers in the stomach or intestines. Adults and children with severe reflux must be evaluated for an underlying medical condition known as a ‘hiatus hernia’.
Exercise, injury or even poor posture can be associated with pain in the muscles of the chest wall. This is often alleviated by deep tissue massages and painkillers. Usually muscular pain is not associated with cough or changes in breathing. A medical condition known as fibromyalgia can cause muscular chest pain but it is rarely isolated to this region. Often, it affects the limbs as well.
The rib cage has joints and these can become inflamed (costochondroitis). Usually, only one joint is affected but sometimes more than one may become inflamed. The pain is often localized to the affected joint and is not associated with cough or difficulty in breathing.
Tumours in the ribcage, lungs or breasts can cause chest pain. If the tumor is in the ribs or muscles, you may be able to feel it. Tumors in the lungs cannot be felt on touch but they may cause symptoms such as coughing up blood or difficulty breathing. Breast tumors (especially those that have invaded the chest wall) may present with pain.
Breast pain in most women is related to their menstrual cycle and is often predictable. This is usually related to hormones and does not need treatment unless it is severe. Pain that is unrelated to the menstrual cycle must be evaluated by a doctor as it often indicates an underlying breast problem. In pregnant and breast feeding mothers, pain may be due to inflammation (mastitis) or infection (abscess) of the breast.
Severe anxiety or panic attacks often present with rapid breathing, chest pain, palpitations and even dizzy spells. Unlike other causes of chest pain, anxiety attacks are often triggered by an emotional event and often resolve once the person calms down. Severe anxiety can be debilitating and significantly affects the quality of one’s life. In these cases, it may be necessary to start one on medication to reduce the anxiety.
Sometimes narrowing of the spaces in the backbone or herniation of a disc in either the neck or the chest area may cause compression of nerves that supply the chest. This can cause chest pain.
Oesophagus (food pipe) problems
If your food pipe is not allowing food to move smoothly down from the throat to the stomach, you may get chest pain. This may occur if the opening into the stomach is too ‘tight’ (due to high pressure) or if the muscles of the food pipe are contracting in an unco- ordinated manner.
What to do
If you have chest pain and are unsure of the cause, visit your doctor. Carry any medication you may be using for the pain. In most cases, a thorough history and physical examination should be able to guide your doctor as to what is causing the pain. Any diagnostic tests required will depend on your symptoms.