Causes and management of chest pain

DR MAXWELL ADEYEMI

Chest pain is generally a common complaint which may indicate a variety of medical issues. Some of these conditions may be trivial, while some can be life-threatening. Chest pains vary depending on the individual affected and the intensity, duration and location of the pain. It may often present as a sharp, stabbing, burning, cramping or dull ache on the chest depending on the cause.

Causes of chest pain

Heart-related causes:

Myocardial infarction, also known as a heart attack, is due to a blockage of blood-flow to the heart.

Angina is an occlusion or blockage of blood vessels leading to the heart which causes injury to the heart.

Pericarditis occurs when the membrane covering the heart gets inflamed.

Myocarditis is an inflammation of the heart muscle.

Cardiomyopathy refers to several heart muscle diseases that cause the muscle to thicken or experience other complications that affects the heart's ability to pump blood.

Other causes of chest pain may include:

Heartburn or acid reflux occurs when stomach acid moves back up into the tube that connects the throat to the stomach (the esophagus), irritating the lining of the esophagus and causes a burning pain in the chest.

Peptic ulcers occur when sores develop in the lining of the stomach, esophagus or small intestine. While stomach pain is the typical symptom in this condition, it may present as a chest pain at times in some patient.

Dysphagia is a swallowing disorder that commonly affects the top of the throat or further down the esophagus, making swallowing difficult and painful.

Pleurisy, the membrane that surrounds the lung, can get inflamed and cause chest pain which often increases when you cough or inhale.

Pulmonary embolism occurs when blood clots gets lodged in an artery in the lung and block the blood flow to the lung. This causes chest tightness and pain that feels like a heart attack.

Lung cancer interferes with healthy functioning of the lung and causes chest pain which increases with deep breathing and cough.

Pneumothorax, also referred to as lung collapse, occurs when air leaks into the space between the lung and the chest wall, preventing the lung from expanding when breathing and results in chest pain.

Costochondritis occurs when the cartilage of the rib cage gets inflamed, causing chest pain that can mimic a heart attack.

Panic attacks may cause chest pains and is usually associated with racing heartbeat, rapid breathing and profuse sweating. It may also be accompanied by dizziness, nausea and a feeling of intense fear.

Pneumonia, an infection of one or both lungs, occurs when the small air sacs that help oxygen get into the blood become inflamed and may become filled with pus or fluid. This can lead to chest pain, cough, fever and other symptoms.

Pancreatitis, the acute inflammation of the pancreas, can cause upper abdominal pain and in some cases, chest pain.

Asthma is a reversible airway obstruction that can cause the lung to become inflamed, narrow, swollen and go into spasm. This can cause chest tightness, chest pain, shortness of breath, coughing and wheezing.

Injury trauma such as muscle strain or a broken rib can cause chest pain. Movement of the upper body, turning or twisting can aggravate the discomfort and chest pain that comes with such soft-tissue injuries or traumas.

Hiatus hernia is a condition in which part of the stomach pushes up through the diaphragm, the muscle that separates the chest from the abdomen. this can cause chest tightness and chest pain.

Shingles is a viral infection caused by the virus Varicella zoster. The rash usually wraps around one side of the chest and can be very painful.

Severe anxiety can cause sudden, sharp chest pain. This mental-health condition can occur on its own, but some persons can have anxiety attacks after a stressful or emotional event.

Cholelithiasis (gall bladder stones) and cholecystitis (inflammation of the gall bladder) are conditions that affect the gall bladder and can cause chest pains.

Aortic aneurysm is a weakness in the wall of the aorta, the largest blood vessel in the body. It can also progress to aortic dissection (a tear within the layers of the aortic wall) and cause blood to leak out, or it may rupture causing blood to gush out of the aorta. These can cause sudden, sharp pains in the chest and upper back and often require immediate medical attention.

Fibromyalgia usually presents with a dull chest pain that can last for months. It is often associated with muscular and joint pain in other parts of the body. It may also be accompanied by fatigue, sleep disorder, headaches and mood changes.

There are other causes of chest pains including scoliosis, large and heavy breasts, pectus excavatum (a congenital deformity of the chest wall that causes several ribs and the breastbone to grow inwards), chronic obstructive pulmonary disease and pulmonary hypertension.

Managing chest pains

The investigation, diagnosis and treatment of chest pains begins with a good history-taking of the type of pain and the character of the pain, after which a careful examination is done. Blood tests, chest X-rays, CT and MRI scans, as well as an ECG may be ordered.

Depending on the cause of the chest pains, your healthcare provider with institute-appropriate treatment for pain relief and possible referrals may be warranted to relevant disciplines for further care and managements.

It is always safer to check with your physician if you have chest pains to ascertain the cause and get the right treatment.

Contact Dr Maxwell on 363-1807 or 757-5411.