Introduction to chest pain

Chest pain imageChest pain is one of the most commonly presented problems to the doctor. It is both a common and threatening problem because in many instances the cause is potentially serious, especially in chest pain of sudden onset. The main causes of acute chest pain include heart, gut, respiratory and muscular causes. As heart disease is the leading cause of death in Western nations it is important for patients at risk to seek medical advice if they do experience chest pain.

Causes of chest pain

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen and can be considered in terms of whether it is caused by a heart problem or a problem in another part of the body. Many people with chest pain fear a heart attack. However, there are many possible causes of chest pain. Some causes are mildly inconvenient, while other causes are serious, even life-threatening. Any organ or tissue in the chest can be the source of pain, including the heart, lungs, oesophagus, muscles, ribs, tendons, or nerves. Angina is a type of heart-related chest pain. This pain occurs because your heart is not getting enough blood and oxygen. Angina pain can be similar to the pain of a heart attack, but is generally less severe and shorter in duration.
Angina is called stable angina when chest pain begins at a predictable level of activity, for instance, when you walk up a steep hill. However, if chest pain happens unexpectedly after light activity or during rest, this is called unstable angina. This is a more dangerous form of angina – if this occurs, you should seek medical attention as soon as possible. Heart-related chest pain can also be caused by a problem with the heart valves, or can occur due to irritation of the lining around the heart after a person has had an infection.

Other causes of chest pain include:

  • Pneumonia (infection in the lung), pulmonary embolism (caused by a blood clot to the lung), pneumothorax the collapse of a small area of a lung, or inflammation of the lining around the lung (pleurisy). In these cases, the chest pain often worsens when you take a deep breath;
  • Strain or inflammation of the muscles and tendons between the ribs;
  • Referred pain from back/spine problems which goes to the chest;
  • Anxiety and rapid breathing;
  • Problems with the digestive system, such as indigestion or heartburn and gallstones;
  • Shingles can also cause chest pain (usually accompanied by a rash a few days later).

Patients should seek medical attention if they experience any of the following:

  • Sudden crushing, squeezing, tightening, or pressure in your chest;
  • Nausea, dizziness, sweating, a racing heart, or shortness of breath;
  • They know they have angina and their chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual;
  • Angina symptoms occur at rest;
  • They have sudden sharp chest pain with shortness of breath, especially after a long trip, a stretch of bedrest (for example, following an operation), or other lack of movement that can lead to formation of a blood clot in the leg;
  • Chest-wall pain persists for longer than 3 to 5 days.

A person’s risk of heart attack is higher if they have a family history of heart disease, smoke or use cocaine, have high cholesterol, high blood pressure, or diabetes.

Treatment of chest pain

Emergency measures will be taken, if necessary. Hospitalization may be required in difficult or serious cases, or when the cause of the pain is unclear. Normally, the doctor will ask some questions about the pain and the patient’s past health, perform a physical examination, and monitor their vital signs (temperature, pulse, rate of breathing, blood pressure). Following this, the patient will normally be put on oxygen, and have some tests done (blood tests, chest x-ray and ECG of the heart). If the pain is severe, medications are given to control it. Treatment will depend on the results of the tests and the doctor’s findings. Sometimes, further tests are necessary, or the patient may be started on some new medications. The use of spinal cord stimulation is currently being investigated for treatment of chest pain in patients with angina pectoris. If the chest pain was caused by a heart problem, the patient may be advised on ways to improve their health and hopefully prevent more heart problems in the future.

Measures include:

  • Achieving and maintain normal weight;
  • Control high blood pressure, high cholesterol, and diabetes;
  • Avoid cigarette smoking and second-hand smoke;
  • Eat a diet low in saturated and hydrogenated fats and cholesterol, and high in starches, fibre, fruits, and vegetables;
  • Exercise 3 hours per week or more (such as 30 minutes per day, 6 days per week);
  • Reduce stress.

Drugs used in the treatment of chest pain:

Diseases presenting with chest pain include:


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