Chest pain

2021-08-01 03:05 PM

Chest pain can arrive suddenly at any time. Fortunately, chest pain is not always a heart attack and cardiovascular problem.

Define

Chest pain can arrive suddenly at any time. Try to ignore it at first, but can chest pain cause fear and anxiety because you think you might be having a heart attack?

Chest pain is one of the common reasons most people need emergency medical help. Each year emergency physicians evaluate and treat millions of people with chest pain.

Fortunately, chest pain isn't always a sign of a heart attack. Usually, chest pain is not related to any cardiovascular problems. But even if chest pain has nothing to do with the cardiovascular system, the problem can still be important and the value lies in the time period being assessed.

Symptoms

A variety of health problems can cause chest pain. In many cases, the underlying cause has nothing to do with the heart, although it's not easy to pinpoint.

Chest pain linked to heart problems

In general, chest pain, related to a heart attack or other heart-related problem, is present when one or more of the following are present:

Pressure, squeezing, or tightness in the chest.

Pain radiates to the neck, jaw, shoulder, and arm, especially the left arm.

Pain lasts more than a few minutes, goes away and comes back, or changes in intensity.

Shortness of breath, sweating, dizziness, or nausea.

Chest pain related to the non-cardiac problem

Means not related to a heart problem and frequently associated with:

Burning sensation behind the breastbone.

Ợ sour or food feeling in the mouth.

Difficulty swallowing.

Pain lessens or gets worse when changing body position.

Pain that increases in intensity when taking a deep breath or coughing.

Pain when pressing on the chest.

If you have new or unexplained chest pain or suspect a heart attack, call for emergency medical help right away. Don't waste time trying to self-diagnose heart attack symptoms.

Every minute is very important if you are having a heart attack. Going to the emergency room early can save lives, or provide peace of mind if there are no serious health problems.
 
Do not drive yourself to the hospital, unless there is no other option. Driving by yourself puts you at risk if your condition suddenly worsens.

Causes

Chest pain has many possible causes, all of which deserve medical attention.

Cause of heart

Heart attack. A heart attack is the result of a blood clot blocking blood flow to the heart muscle.

Chest pain. Hard, thick, cholesterol plaques can gradually build up on the inner walls of the coronary arteries – the arteries that carry blood to the heart. These plaques temporarily narrow the coronary arteries and restrict blood supply to the heart muscle, especially during exercise. Restricted blood flow to the heart can often cause stable angina or unstable angina.

Aortic dissection. This life-threatening condition involves the aorta. If the inner layers of the blood vessel separate, causing blood to flow between them, the result is an unexpected tear. Aortic dissection can result from a hard blow to the chest or develop as a complication of uncontrolled hypertension.

Coronary artery spasm. In coronary spasm, sometimes called Prinzmetal's angina, the arteries that supply blood to the heart muscle constrict, temporarily stopping blood flow through the site of the spasm. It occurs at rest and can coexist in people with coronary artery disease - a buildup of plaque in the walls of the coronary arteries.

Pericardial membrane. Inflammation of the membranes around the heart, often associated with viral infections.

Heart-related problems. Other heart problems, such as myocarditis, an inflammation of the heart usually caused by a viral infection, can cause chest pain. Certain types of heart muscle disorders, such as hypertrophic cardiomyopathy, can also cause chest pain.

Cause of digestion

Heartburn. Stomach acid backing up into the esophagus can cause heartburn and a burning sensation behind the breastbone.

Esophageal spasm. Disorders of the esophagus, the tube that runs from the throat to the stomach, can make swallowing difficult and even painful. Esophageal spasm, a problem that affects a small group of people with chest pain.

Diaphragm hernia. In this problem, part of the stomach slides up above the diaphragm into the chest. This can cause pressure in the chest or pain, especially after eating, as well as heartburn.

Cardiac contraction. In swallowing disorders, the valve in the lower esophagus does not open properly to allow food to enter the stomach. Instead, the food spills into the esophagus, causing pain.

Gallbladder or pancreas problems. Gallstones or acute inflammation of the gallbladder or pancreas can cause abdominal pain that radiates to the chest.

Musculoskeletal causes

Rib cartilage tablets. In this problem, also known as Tietze's syndrome - the cartilage of the rib cage, especially the costal cartilage that attaches to the sternum, becomes inflamed. The result is chest pain, which often gets worse when pressing on the breastbone or on the ribs near the sternum.

Muscle pain. Chronic pain syndromes, such as fibromyalgia, can have persistent pain involving the chest muscles.

Nerve injury or rib compression. A bruise or broken rib, as well as nerve compression, can cause chest pain.

Chest pain due to breathing

Pulmonary embolism. This causes chest pain, which occurs when a blood clot in a pulmonary artery, blocks blood flow to lung tissue. This life-threatening condition occurs without prior risk factors, such as recent surgery or immobilization.

Lung. Sharp pain in the chest at one point and aggravated by inhalation or coughing occurs when the lungs and pleura become inflamed. More rarely, autoimmune diseases, such as lupus. An autoimmune disease in which the body's immune system mistakenly attacks healthy tissue.

Other lung problems. Hypertension in the arteries that carry blood to the lungs and asthma can also create chest pain.

Other causes

Anxiety - panic. If in a state of intense fear, it may be accompanied by chest pain, tachycardia, rapid breathing, sweating, and shortness of breath.

Shingles disease. An infection of the nerves caused by a virus can cause pain and blisters on the back and around the chest wall.

Cancer. Cancer may be associated with chest pain or cancer that has spread from another part of the body to cause chest pain.

Tests and diagnostics

In the emergency room, an evaluation for chest pain will likely include blood pressure, heart rate, and an immediate temperature check. In addition, the doctor will ask some questions about chest pain.

Chest pain is not always a signal of a heart attack. But that's what the emergency room doctor will test for the first time because it's most likely to be life-threatening. They may also check for aortic dissection or a life-threatening lung problem, such as a pulmonary embolism or pulmonary hypertension, or a pneumothorax that can cause chest pain.

Possible tests to determine the cause of chest pain include:

Electrocardiogram (ECG). This test can help your doctor diagnose heart disease as well as other heart problems. It records the electrical activity of the heart through electrodes attached to the skin. The rhythm and electrical impulses that pass through the heart are recorded as waves displayed on a screen or printed on paper. Because the heart muscle is damaged, the heart muscle does not conduct electrical impulses normally, the ECG can show that a heart attack has occurred or is in progress.

Blood tests. Your doctor may order blood tests to check for increased levels of certain enzymes commonly found in the heart muscle. Damage to heart cells from a heart attack can show enzymes in the blood, over a period of several hours.

Chest X-ray. Chest X-rays allow doctors to check the condition of the lungs, the size and shape of the heart, and the major blood vessels. Doctors may also use chest X-rays to check for tumors in the chest and to look for lung problems that can cause chest pain, like pneumonia or pneumothorax.

Stress test. Measures to check the heart and blood vessels respond to exercise, because the pain may be related to the heart. There are many types of stress tests. Walking on a treadmill or cycling may be required while connected to the ECG. Or you may be given an intravenous drug to stimulate the heart in a similar way to exercise. Exercise can be combined with imaging of the heart using ultrasound or radioactive material (nucleus).

Echocardiography. An echocardiogram uses sound waves to create a video image of the heart. This image can help your doctor identify heart problems.

Coronary catheterization (angiogram). This test helps doctors identify arteries that supply blood to the heart muscle that may be narrowed or blocked. A dye is injected into the arteries of the heart through a catheter, usually in the groin, to the arteries in the heart. When the arteries are filled, it is seen on radiographs and video.

Computerized tomography. Different types of CT can be used to examine the heart's arteries, looking for signs of calcium, which indicate atherosclerotic plaque may be accumulating and blocking the arteries that supply blood to the heart. CT can also be done with dye to show the heart arteries.

Magnetic resonance imaging (MRI). An MRI is an imaging technique that uses a magnetic field and radio waves to create cross-sectional images of the body. Cardiac MRI is sometimes done to look for evidence of heart damage or inflammation of the heart muscle.

Endoscopic. Instruments attached to a camera are passed down the throat, allowing the doctor to examine the esophagus and stomach and stomach problems that can cause chest pain.

Many types of chest pain may at first seem to be related to a heart problem. But after careful evaluation, doctors can distinguish between symptoms of chest pain caused by heart disease or not.

Treatments and drugs

Treatment of chest pain due to cardiac causes

If a heart problem is the cause of your chest pain, medications such as:

Aspirin. Aspirin inhibits blood clotting, which helps maintain blood flow through narrowed heart arteries, and aspirin can significantly reduce mortality. You may be asked to chew aspirin to accelerate its absorption. Aspirin is recommended for most people who have had a heart attack.

Nitroglycerin. This medication is used to treat angina, temporarily widen the narrowing of blood vessels, and improve blood flow to and from the heart.

Beta-blockers. These drugs relax the heart muscle, slow the heart rate, and lower blood pressure, reducing myocardial oxygen demand. These drugs help limit the amount of damage during a heart attack and prevent a recurrent heart attack.

Thrombolysis. These drugs also called clot busters, help dissolve a blood clot that is blocking blood flow to the heart. These medications are most effective within an hour after the symptoms of a heart attack begin.

Ranolazine (Ranexa). This is a relatively new drug in the treatment of chronic angina. It is used only when other medicines for angina are not effective because it can cause a problem called QT prolongation, which can increase the risk of heart rhythm problems. It should be used with other angina medications, such as calcium channel blockers, beta-blockers, or nitroglycerin.

ACE inhibitors and angiotensin receptor blockers (ARBS). These drugs allow blood to flow from the heart more easily. Your doctor may prescribe an ACE inhibitor or an ARBS if you've had a moderate to severe heart attack and have reduced your heart's work. These drugs also lower blood pressure and may prevent a second heart attack.

Calcium channel blockers. When treating coronary artery spasm, doctors sometimes use cardiovascular drugs such as calcium channel blockers to relax the coronary arteries and prevent spasms.

Heart attack treatment

If you are clearly having a heart attack, you may be treated with thrombolytics or undergo a procedure such as:

Angioplasty and stenting. In angioplasty, also known as percutaneous coronary intervention (PCI), the doctor inserts a catheter with a special balloon into a blocked coronary artery. The balloon is inflated to widen the artery and restore blood flow to the heart. Then, a small mesh coil (stent) is usually inserted to keep the artery open. Angioplasty is performed as quickly as possible.

Bridge surgery. This procedure creates an alternate route for blood to bypass where the coronary artery is blocked.

Treatment of angina pectoris

Doctors usually treat angina pectoris first with medication. Medications can be started in the emergency room, including aspirin, nitroglycerin, beta-blockers, and blood thinners.

If unstable angina is present, an immediate coronary catheterization may be needed for subsequent angioplasty and stenting. In some cases, coronary surgery may be necessary.

Treatment of chest pain problems due to other causes

Heart and lung problems can be treated initially in the emergency room. If a pulmonary embolism is clearly present, it can be urgently treated with blood thinners, sometimes including thrombolytics.

Aortic dissection usually requires emergency surgery.

Treat non-cardiovascular causes

If emergency physicians determine that there is danger, a personal physician or a specialist may be called for further evaluation. Treatment for the cause of noncardiac chest pain depends on the type of problem. These problems and treatment include:

Heartburn. If symptoms suggest heartburn, a prescription for antacids may be needed in the emergency room.

If heartburn problems are frequent (at least once a week), your doctor or a doctor who specializes in stomach and intestinal problems (gastroenterologist) may order further testing. If left untreated, frequent heartburn can sometimes lead to scarring and narrowing of the esophagus. Treatment for chronic heartburn may include dietary modifications, antacids, acid blockers, or other prescription medications, in some cases requiring surgery.

Anxiety - panic. This anxiety related to chest pain can be treated with anti-anxiety medications, relaxation techniques, and counseling to figure out what might be the trigger. Anxiety is often confused with heart attacks, and many people are seen in emergency rooms for this problem. But once the condition is diagnosed, treatment can be given to help keep it under control.

Lung. Inflammation of the pleura, the lungs, can have many causes, and more rarely, autoimmune conditions like lupus. Your doctor will identify and treat the underlying disease causing it. Pain relievers can help minimize pain until the inflammation subsides.

Costochondritis. Treatment for rib cartilage inflammation is usually a nonsteroidal anti-inflammatory drug, such as ibuprofen.

Muscle pain, injured ribs, or pinched nerves. Chest pain from injured ribs, nerve and muscle compression should improve with time and self-care measures are recommended.

Swallowing disorder. Swallowing disorders have many causes, which can often be treated with medication, minor surgery, or endoscopic techniques. You will be referred to a specialist for evaluation and treatment.

Shingles disease. Treatment with acyclovir or a similar antiviral drug is best, initiated as quickly as possible and preferably within 24 hours of the onset of pain or burning, and before the appearance of blisters. Doctors use other treatments, such as pain relievers and antihistamines, to control symptoms such as pain and itching.

Gallbladder or pancreas. Surgery may be needed to treat inflammation of the gallbladder or pancreas that is causing pain that radiates from the abdomen to the chest.

Chest pain can be one of the most difficult symptoms to explain. But taking the time to go to the emergency room for chest pain for an evaluation can provide peace of mind, and possibly even save lives.