Chest Pain

Chest pain is a discomfort that occurs in the area of the body between the neck and the abdomen. Although it is often associated with a heart attack, it may indicate a wide variety of diseases and conditions, making it important to monitor its progression and accompanying symptoms.

The prognosis of chest pain varies depending on the underlying cause. When it is due to muscle contractures or gastrointestinal disorders, for example, it usually resolves without complications with appropriate treatment. However, if it is caused by a myocardial infarction or a pulmonary embolism, immediate medical attention is essential to prevent life-threatening situations.

Symptoms

Chest pain may present in three forms:

• Stabbing pain: similar to a sharp prick; although not always, it often occurs with movement and subsides at rest. It is generally associated with muscle strain, cartilage disorders, anxiety, or digestive problems. If it worsens when coughing or taking a deep breath, it is usually related to pulmonary diseases.
• Dull pain: constant, uncomfortable, and diffuse, making it difficult to localize precisely. Depending on the cause, it may remain localized or radiate to the arms or neck. It may improve with movement in some cases and worsen in others. It may be a sign of myocardial infarction or muscle tension.
• Oppressive pain: characterized by a constant pressure in the chest, which may indicate angina pectoris or myocardial infarction.

Symptoms commonly accompanying chest pain when related to cardiovascular disease include:

• Shortness of breath
• Fatigue
• Cold sweating
• Tachycardia: increased heart rate
• Indigestion
• Heartburn
• Nausea
• Lightheadedness

It is essential to seek emergency care when chest pain presents with the following characteristics:

• Sudden onset pain, especially if oppressive
• Pain radiating to the left arm, jaw, or between the shoulder blades
• Tachycardia
• Respiratory distress
• Dizziness, nausea, and sweating
• Difficulty swallowing
• Fever
• Productive cough with greenish sputum

Causes

Chest pain may have a wide range of causes. The most notable include:

• Cardiovascular diseases: affecting the heart and blood vessels.
• Angina pectoris: reduced blood flow to the heart muscle causing pain.
• Myocardial infarction: blockage of coronary blood flow, leading to oxygen deprivation and death of cardiac cells.
• Aortic dissection: tear in the inner layer of the aorta, allowing blood to flow between layers and separate them. If blood passes through the outer layer, it becomes life-threatening.
• Pericarditis: inflammation of the membrane surrounding the heart.
• Pulmonary diseases: affecting lung structures and airways.
• Pulmonary embolism: a blood clot forms in a pulmonary artery, usually originating from a deep vein in the legs.
• Pneumothorax: air enters the pleural space, causing lung collapse.
• Pneumonia: infection causing inflammation of the alveoli, which fill with pus.
• Pleurisy: inflammation of the pleura.
• Pulmonary hypertension: elevated pressure in pulmonary arteries (>25 mmHg at rest), leading to right heart strain and eventual weakening.
• Bronchitis or pneumonia: infection-induced inflammation often causing pain, especially when coughing.
• Bronchospasm: sudden contraction of bronchial muscles, narrowing airways and impairing breathing.
• Parenchymal lung diseases: affecting functional lung tissue and impairing gas exchange, leading to inflammation and fibrosis.
• Digestive diseases: affecting gastrointestinal organs.
• Gastroesophageal reflux disease (GERD): stomach acid reflux due to dysfunction of the lower esophageal sphincter.
• Dysphagia: difficulty swallowing, sometimes causing painful passage of food.
• Gallstones: cause abdominal pain that worsens after eating and may radiate upward.
• Gastritis: inflammation of the gastric mucosa causing epigastric pain and possible burning sensation ascending the esophagus.
• Pancreatitis: inflammation of the pancreas, often radiating pain to the back and chest.
• Peptic ulcer: burning pain that may radiate and ascend due to associated acidity.
• Esophageal stenosis: narrowing of the esophagus, hindering food passage and causing pain.
• Musculoskeletal disorders: affecting muscles, bones, and cartilage.
• Costochondritis: inflammation of the cartilage connecting ribs to the sternum, causing sharp pain often mistaken for heart attack.
• Muscle contracture: due to overexertion, poor posture, or excessive tension.
• Intercostal muscle tear: resulting from trauma or intense coughing.
• Rib fracture or fissure
• Trauma-related hematomas
• Other conditions:
• Herpes zoster: reactivation of varicella-zoster virus causing painful vesicular rash along the chest and back.
• Anxiety: acute stress causing muscle tension and chest pressure.
• Panic attack: intense fear producing symptoms similar to myocardial infarction, including sweating, dyspnea, tachycardia, nausea, and chest pressure.

Risk Factors

The risk of chest pain is higher in the following cases:

• Personal or family history of heart disease
• History of pneumothorax
• Chronic lung diseases
• Smoking
• Hypercholesterolemia
• Arterial hypertension
• Diabetes
• Sedentary lifestyle
• High air pollution exposure
• Severe stress
• Coagulation disorders
• Prolonged immobility due to illness or post-surgery

Complications

Chest pain may lead to the following complications:

• Cardiovascular causes:
• Severe arrhythmias
• Heart failure
• Cardiac tamponade
• Aortic rupture
• Death
• Pulmonary causes:
• Dyspnea
• Respiratory arrest
• Digestive causes:
• Chronic cough
• Asthma
• Barrett’s esophagus (precancerous condition)
• Gastrointestinal bleeding
• Esophageal cancer
• Musculoskeletal causes:
• Chronic pain
• Recurrence of costochondritis
• Restricted movement
• Flail chest (multiple rib fractures)
• Internal organ injury due to instability
• Respiratory infections
• Other causes:
• Postherpetic neuralgia
• Dissemination of herpes zoster virus to lungs or liver
• Social isolation in cases of anxiety or panic disorder

What specialist treats chest pain?

Chest pain is typically managed within the specialties of Emergency department, Cardiology, Angiology and Vascular surgery, Pulmonology, Rheumatology, Gastroenterology, Family and community medicine, and Infectious diseases.