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Pain in any region of the chest is called Chest pain. It is the discomfort or soreness in or around the chest. It may be a symptom of a number of serious diseases and it is one of the most common reason of people seeking medical emergency. Causes of chest pain vary from life-threatening conditions to relatively harmless conditions. Acute coronary syndrome (ACS), tension pneumothorax, pericardial tamponade, pulmonary embolism, and esophageal rupture are some of the life-threatening conditions causing chest pain. Chest pain can be divided generally into cardiac chest pain (heart related causes) and non- cardiac chest pain (not caused by heart condition).
Chest pain may range from dull ache to sharp stabbing pain depending upon the triggering factor. It may also cause burning, heaviness, choking or shortness of breath and pressure or crushing sensation. The pain may spread to the neck, jaws, arms, back and shoulders. The pain can be precipitated by exertion, stress and/or exposure to cold.
History and physical examination are of crucial importance in assessing the causative factor and determining the need for further testing. Onset and location of chest pain may help in determining the origin of pain. An abrupt onset of pain may indicate aortic dissection and pneumothorax. Spread of pain to the neck, jaws and arms may suggest its origin from coronary artery disease. Pain typically worsening with respiration may indicate pleurisy. In angina pectoris pain is provoked by exertion. Pain of oesophageal origin worsens with swallowing.
In emergency evaluation of heart related causes electrocardiogram (ECG), chest x-ray, echocardiography, CT scanning are useful. Blood troponin levels, electrolytes and renal function test, and creatine kinase are also helpful in diagnosis. Other investigations such as CT pulmonary angiogram, serum lipase levels, liver enzymes level etc are advised based on the complaints of the patient.
Management of chest pain is based on the underlying cause of the pain and the stage of care. Preventive measures such as avoiding smoking, healthy life style eg. Low fat foods, fiber diets and exercise are of great importance in both the cardiac and non- cardiac related chest pain.
The prognosis of the chest pain is fair to poor depending upon the cause and type of pain, condition of the patient and the stage at which the treatment is started. Right side or left side chest pain could mean different things.
Types of Chest Pain-
Chest pain can be classified based on the underlying conditions causing it
- Cardiac (caused by heart disease).
- Pulmonary chest pain (caused by lung disease)
- Musculoskeletal (caused by problems affecting the chest wall)
- Gastrointestinal (caused by digestive disorders)
- Psychiatric (caused by mental disorders)
Different Diseases Dausing Chest Pain:
1. Acute coronary syndrome:
It is a condition caused by sudden reduction of blood flow or blockage to the heart. It is most commonly caused by clot formation or rupture of plaque in heart arteries. It includes a range of conditions like myocardial infarction (ST segment elevation myocardial infarction and non- ST segment elevation myocardial infarction) and unstable angina.
The symptoms include pressure or squeezing sensation over the chest while resting or doing light activity. Excessive sweating, nausea and weakness may also be associated with it. The pain may radiate to neck, back, jaws and arms. Pain may last for more than few minutes to several hours depending upon the amount of blockage.
Treatment includes medication such as blood thinners and beta blockers etc. Surgery may be required.
2. Angina pectoris
It is the chest pain caused by insufficient blood flow to the heart muscle, usually caused by spasm or obstruction of the coronary arteries, arrhythmia, anemia etc. it can be of two types stable and unstable. In case of stable angina, chest pain worsens with activity and no or minimal pain at rest or after taking nitroglycerin. Unstable angina may occur at rest and pain worsens. It is usually grouped with symptoms similar to acute coronary syndrome. Nitroglycerin is the specific medicine used in angina.
It is an inflammation of the pericardium (a thin sac or membrane surrounding the heart). It can be caused by viral infection, bacterial infection or heart attack. Pain ranges from dull ache to sudden, sharp and stabbing pain. Pain typically worsens while lying down and breathing. Nonsteroidal antiinflammatory drugs, corticosteroids are usually given to treat the condition. Underlying cause is diagnosed and treated at the same time.
If the inflammation includes the heart muscle or myocardium then it is called as myopericarditis.
4. Aortic dissection
It occurs due to tear in the inner layer of the aorta allowing the blood to flow between the layers of the aortic wall and forces the layers apart. Aorta is the large vessel branching off the heart. Rupture through the outer layer of aorta can also occur causing fatal bleeding and may quickly lead to death due to insufficient blood flow to heart. It is more common in patients with high blood pressure, so blood pressure should be controlled as a preventive measure. Treatment of aortic dissection depends upon the part of the aorta involved. It usually requires surgery.
5. Pulmonary embolism
It is the blockage of one or both the pulmonary arteries within the lungs by blood clots. Blood clots travel from the lower extremities (deep vein thrombosis of the leg) through the right heart chambers and lodge in the pulmonary arteries. Symptoms include shortness of breath, coughing up blood, chest pain worsening on breathing etc. Apart from these, symptoms of deep vein thrombosis (DVT) can also be seen such as painful swelling of one or both legs, ankle or foot. Risk factors for DVT includes prolonged bed rest, contraceptive pills, injury or surgery etc.
Pleurisy (pleuritis) is inflammation of the membranes (pleura) lining the lungs and the inner chest wall. It is usually associated with excess fluid accumulation between the pleura (pleural effusion). Due to the inflammation of the tissues the membranes rub directly against each other and causes sharp pain on the inflamed side of the chest.
It can be caused due to a number of disorders such as viral infections eg. flu (influenza), bacterial infections eg. Tuberculosis, pneumonia etc, and fungal infections. Pulmonary embolism, congestive heart failure, lung cancer, autoimmune diseases eg. Lupus etc may also cause pleurisy.
Sharp and stabbing chest pain while breathing is usually the chief complaint. Pain is typically localised to the area that is inflamed. Pain worsens while deep breathing, coughing, laughing, sneezing or moving. Continuous, dull chest pain may also occur. Pain may extend to shoulders, neck and back as well.
Treatment includes removing the fluid or air from the pleural space using Thoracentesis, ultrasound etc. Symptomatic treatment includes medications such as Nonsteroidal antiinflammatory drugs, narcotics, cough syrups etc. Corticosteroids and bronchodilators are also used.
7. Pulmonary hypertension
Elevated pressure in the pulmonary arteries causes pulmonary hypertension. Chest pain and shortness of breath are the main symptoms which are pronounced during exertion. Treatment includes medication and oxygen therapy.
8. Chronic obstructive lung disease
Pneumonia, Asthma, Chronic obstructive lung diseases are also associated with chest tightness or pain. Shortness of breath, cough also occurs.
9. Heart burn
Pain and burning sensation behind and below the sternum or breastbone is called heart burn. Burning pain usually occurs after eating, in the evening or night and while lying down. It is caused by regurgitation of the stomach acid in the oesophagus or food pipe (tube connecting throat to stomach). Spicy foods, fatty meals, alcohol etc are some of the triggering factors. Treatment includes antacids, proton pump inhibitors etc.
10. Gall bladder and pancreatic disorders
Inflammation of the gall bladder is called as cholecystitis. It is often caused by stones blocking the tube leading from the gall bladder to the small intestine. It is characterized by severe pain in the upper right abdomen and bloating. The pain usually radiates to the chest. Treatment includes low fat diet, medications, cholecystectomy, laparoscopic surgery etc.
Pancreatitis or inflammation of the pancreas causes pain in the upper abdomen, nausea and vomiting. Pain may also radiate to the chest. Pancreatitis can be caused by gall stones, heavy alcohol use etc. So the management includes treatment of the underlying cause.
It is an inflammation of the cartilage that connects a rib to the sternum. It can be caused by trauma or muscle strain. Pain and tenderness of the sternum and ribs indicates it and the pain worsens with deep breathing or coughing.
Treatment includes medications and therapy.
12. Injured ribs
Injury to ribs or broken and bruised ribs may also cause chest pain.
13. Panic attack
Sudden episodes of extreme distress or fear may cause chest pain and palpitations. Shortness of breath and sweating can also be associated with it.
A chest pain could mean a lot of things. You can try some Home Remedies for Chest Pain or consult a doctor immediately for check up.