Chest pain

Answer 1

Definition

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

Alternative Names

Chest tightness; Chest pressure; Chest discomfort

Considerations

Many people with chest pain fear a heart attack. However, there are many possible causes of chest pain. Some causes are not dangerous to your health, while other causes are serious and even life-threatening.

Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to the chest from the neck, abdomen, and back.

Common Causes

Heart problems that can cause chest pain:

• Angina is a type of heart-related chest pain. This pain occurs because your heart is not getting enough blood and oxygen. The most common symptom is chest pain that occurs behind the breast bone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.
• Aortic dissection (tearing of the aorta wall) causes sudden, severe pain in the chest and upper back.
• Heart attack pain can be similar to the pain of unstable angina, but more severe.
• Inflammation or infection in the tissue around the heart (pericarditis) causes pain in the center part of the chest.

Lung problems that can cause chest pain:

• A blood clot in the lung (pulmonary embolism), collapse of a small area of the lung (pneumothorax), or inflammation of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.
• Asthmagenerally also causes shortness of breath, wheezing, or coughing.
• Pneumoniacauses chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.

Other causes of chest pain:

• Anxiety and rapid breathing
• Inflammation where the ribs join the breast bone or sternum (costochondritis)
• Shingles(inflammation/infection of the nerve that causes sharp, tingling pain on one side that stretches from the chest to the back)
• Strain or inflammation of the muscles and tendons between the ribs

Chest pain can also be related to the following digestive system problems:

• Achalasia
• Esophageal spasms (abnormal contractions of the muscles in the tube that carries food from the mouth to the stomach)
• Gallbladder (pain often gets worse after a meal, especially a fatty meal)
• Heartburn or gastroesophageal reflux(GERD)
• Pancreatitis (aching pain in the upper abdomen and back)
• Stomach ulcer or gastritis (burning pain occurs if your stomach is empty and feels better when you eat food)

In children, most chest pain is not caused by the heart.

Home Care

For many causes of chest pain, it is best to check with your doctor or nurse before treating yourself at home.

If injury, overuse, or coughing have caused muscle strain, your chest wall is often tender or painful when you press a finger at the location of the pain. This can often be treated at home. Try acetaminophen or ibuprofen, ice, heat, and rest.

If you know you have asthma or angina, follow your doctor's instructions and take your medications regularly to avoid flare-ups.

See: Heartburnfor information about treatment at home.

Call your health care provider if

Call 911 if:

• You have sudden crushing, squeezing, tightening, or pressure in your chest.
• Pain radiates to your jaw, left arm, or between your shoulder blades.
• You have nausea, dizziness, sweating, a racing heart, or shortness of breath.
• You know you have angina and your chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual.
• Your angina symptoms occur at rest.
• You 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 a blood clot in your leg.

Know that your risk of heart attack is greater if you have a family history of Heart disease, you smoke, use cocaine, are overweight, or you have high cholesterol, high blood pressure, or Diabetes.

Call your doctor if:

• You have a fever or a cough that produces yellow-green phlegm.
• You have chest pain that is severe and does not go away.
• You are having problems swallowing.
• Chest wall pain persists for longer than 3 to 5 days.

What to expect at your health care provider's office

Emergency measures will be taken, if necessary. Hospitalization will be required in difficult or serious cases or when the cause of the pain is unclear.

The doctor will perform a physical examination and monitor your vital signs (temperature, pulse, rate of breathing, blood pressure). The physical examination will focus on the chest wall, lungs, and heart. Your doctor may ask questions like the following:

• Is the pain between the shoulder blades? Under the breast bone? Does the pain change location? Is it on one side only?
• How would you describe the pain? (Severe, tearing or ripping, sharp, stabbing, burning, squeezing, constricting, tight, pressure-like, crushing, aching, dull, heavy)
• Does it come on suddenly? Does the pain occur at the same time each day?
• Is the pain getting worse? How long does the pain last?
• Does the pain go from your chest into your shoulder, arm, neck, jaw, or back?
• Is the pain worse when you are breathing deeply, coughing, eating, or bending?
• Is the pain worse when you are exercising? Is it better after you rest? Is it completely relieved or just less pain?
• Is the pain better after you take nitroglycerin medication? After you drink milk or take antacids? After belching?
• What other symptoms are also present?

Diagnostic tests that may be performed include:

• Blood tests (such as LDH, LDH isoenzymes, CPK, CPK isoenzymes, troponin, CBC, and blood differential)
• Cardiac catheterization
• ECG
• Echocardiogram
• Exercise ECG
• Lung scan
• X-rays of the chest

More complex tests may be required, depending on the difficulty of diagnosis or the suspected cause of the chest pain.

Prevention

Make healthy lifestyle choices to prevent chest pain from heart disease:

• Achieve and maintain normal weight.
• Control high blood pressure, high cholesterol, and diabetes.
• Avoid cigarette smoking and secondhand smoke.
• Eat a diet low in saturated and hydrogenated fats and cholesterol, and high in complex carbohydrates, fiber, fruits, and vegetables.
• Get at least 30 minutes of moderate intensity exercise on most days of the week.
• Reduce stress.

References

Brown JE, Hamilton GC. Chest Pain. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 18.

Anderson JL, Adams CD, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2007;116:803-877.

Cayley, Jr WE. Diagnosing the cause of chest pain. Am Fam Physician. 2005;72:2012-2021.

Answer 2

Chest pain can be the result of a variety of ailments, but it should be noted that some are more dangerous than others. Individuals experiencing chest pain should seek emergency medical treatment right away in order to ensure proper health and well-being. Chest pain can come in various degrees of severity, but none should be ignored, as each carries with it a significant health hazard.

One of the most common forms of chest pain arises from symptoms of a heart attack. A heart attack essentially closes off the blood supply leading to the heart, thereby causing pain. A heart attack may not always cause chest pain, and may instead cause pain in the back or head. If you experience sudden, sharp pain in the center of the chest, combined with pain in the left side of the body, you need to seek emergency medical services at once. Doing so may save your heart, your organs and your life.

Chest pain may also be experienced by those with anxiety disorders. When people experience extreme anxiety, they may experience chest pain that resembles that of a heart attack. This is usually the result of the chest muscles contracting to the point of causing pain. Many people that suffer from an anxiety disorder may not experience this type of pain until the disorder has become a major problem. Fortunately, there are a number of medications available through your doctor that can alleviate the symptoms of anxiety, as well as the coinciding chest pain.

Finally, chest pain may be caused by muscle strain or acid reflux. In cases of muscle strain, chest pain may occur only when chest muscles are exerted, as in when a heavy item is lifted. If this occurs, your doctor may be able to recommend a workout routine, as well as prescription muscle relaxers, both of which will allow you to move more freely. Acid reflux may occur as a result of acid buildup in the stomach and esophagus, leading up into the chest area. Once again, your doctor may be able to prescribe medications that can help to alleviate these conditions, thereby alleviating your chest pain.

Answer 3

Definition

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

Alternative Names

Chest tightness; Chest pressure; Chest discomfort

Considerations

Many people with chest pain fear a heart attack. However, there are many possible causes of chest pain. Some causes are not dangerous to your health, while other causes are serious and even life-threatening.

Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to the chest from the neck, abdomen, and back.

Common Causes

Heart problems that can cause chest pain:

• Angina or a heart attack is pain that occurs because your heart is not getting enough blood and oxygen. The most common symptom is chest pain that may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.
• A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body (aortic dissection) causes sudden, severe pain in the chest and upper back.
• Swelling (inflammation) in the sac that surrounds the heart (pericarditis) causes pain in the center part of the chest.

Lung problems that can cause chest pain:

• A blood clot in the lung (pulmonary embolism)
• Collapse of athe lung (pneumothorax)
• Inflammation of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.
• Pneumoniacauses a sharp chest pain that often gets worse when you take a deep breath or cough.

Other causes of chest pain:

• Panic attack, which often occurs with fast breathing
• Inflammation where the ribs join the breast bone or sternum (costochondritis)
• Shingles, which causes sharp, tingling pain on one side that stretches from the chest to the back, and may cause a rash
• Strain or inflammation of the muscles and tendons between the ribs

Chest pain can also be due to the following digestive system problems:

• Spasms or narrowing of the esophagus (the tube that carries food from the mouth to the stomach)
• Gallstonescause pain that gets worse after a meal (most often a fatty meal)
• Heartburn or gastroesophageal reflux(GERD)
• Stomach ulcer or gastritis (burning pain occurs if your stomach is empty and feels better when you eat food)

In children, most chest pain is not caused by the heart.

Home Care

For many causes of chest pain, it is best to check with your doctor or nurse before treating yourself at home.

If injury, overuse, or coughing has caused muscle strain, your chest wall is often tender or painful when you press a finger on the site of the pain. This can often be treated at home. Try acetaminophen or ibuprofen, ice, heat, and rest.

If you know you have Asthma or angina, follow your doctor's instructions and take your medications regularly to avoid flare-ups.

See: Heartburnfor information about treatment at home.

Call your health care provider if

Call 911 if:

• You have sudden crushing, squeezing, tightening, or pressure in your chest.
• Pain spreads (radiates) to your jaw, left arm, or between your shoulder blades.
• You have nausea, dizziness, sweating, a racing heart, or shortness of breath.
• You know you have angina and your chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual.
• Your angina symptoms occur while you are at rest.
• You 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, especially if one leg is swollen or more swollen than the other (this could be a blood clot).

Your risk of having a heart attack is greater if:

• You have a family history of heart disease
• You smoke, use cocaine, or are overweight
• You have high cholesterol, high blood pressure, or diabetes

Call your doctor if:

• You have a fever or a cough that produces yellow-green phlegm
• You have chest pain that is severe and does not go away
• You are having problems swallowing
• Chest pain lasts longer than 3 to 5 days

What to expect at your health care provider's office

Emergency measures will be taken, if needed. You may need to go to the hospital if your heart problem is serious, or the cause of the pain is unclear.

The doctor will do a physical exam and monitor your vital signs (temperature, pulse, breathing rate, blood pressure). The physical exam will focus on the chest wall, lungs, and heart. Your doctor may ask questions such as:

• Is the pain between the shoulder blades? Under the breast bone? Does the pain change location? Is it on one side only?
• How would you describe the pain? (Severe, tearing or ripping, sharp, stabbing, burning, squeezing, tight, pressure-like, crushing, aching, dull, heavy)
• Does it come on suddenly? Does the pain occur at the same time each day?
• Is the pain getting worse? How long does the pain last?
• Does the pain go from your chest into your shoulder, arm, neck, jaw, or back?
• Is the pain worse when you are breathing deeply, coughing, eating, or bending?
• Is the pain worse when you are exercising? Is it better after you rest? Does it go away completely, or is there just less pain?
• Is the pain better after you take nitroglycerin medicine? After you drink milk or take antacids? After belching?
• What other symptoms do you have?

Which tests are done depends on the cause of the pain. Often, one or more of the following tests may be done first:

• Blood tests such as troponin, to rule out a heart attack
• ECG
• Echocardiogram
• CT scan of the chest
• X-rays of the chest

References

Brown JE, Hamilton GC. Chest Pain. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 18.

Anderson JL, Adams CD, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2007;116:803-877.

Sabatine MS, Cannon CP. Approach to the patient with chest pain. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 53.

Reviewed By

Review Date: 05/23/2011

Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 4

When people have chest pain, they're often concerned they're having a heart attack. I'm Dr. Alan Greene and I'd like to talk to you for a moment about the different kinds of chest pain and when it may be an emergency.

It turns out, there are lots of different kinds of chest pain. In fact, almost everything in the chest can hurt in one way or another. Some of the causes are really nothing more than a minor inconvenience. Some of them though are quite serious, even life threatening.

You can have chest pain sure from the heart, but also from pneumonia. You can have chest pain from asthma. You can have chest pain from a blood clot in the lungs. It can be from nothing more than a strain of some of the muscles between the ribs, or nerves. You can also have chest pain that comes from acid reflux of from a stomach ulcer, gallstones. Many, many things can cause chest pain.

You want to call 911 if you are having sudden, crushing chest pain or if your chest pain radiates into the jaw or the left arm. You want to call 911 if your chest pain also causes shortness of breath, or dizziness, nausea, or vomiting. You want to call 911 if you know you have heart disease and you do occasionally have pain but your pain is getting significantly worse than it is ordinarily. Or comes on with less activity than it does otherwise. But whatever the cause of chest pain, unless you're sure what causing it, it's worth contacting your physician to find out what may be going on. It's not a symptom to ignore.

Reviewed By

Review Date: 09/18/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 5

Although chest pain can signify cardiovascular disease, it can also be a symptom of a number of other, less serious medical conditions. Chest pain that is indicative of heart disease is more likely to radiate to the left shoulder, arm, neck and jaw. Conversely, chest pain that is related to acid reflux, muscle, or cartilage disorders tends to stay stationary. In addition, cardiovascular pain is commonly associated with other symptoms such as nausea, sweating, palpitations and anxiety.

Individuals who experience pain anywhere in the chest area should seek emergency medical attention. Although the pain may turn out to be innocuous, it may be the sign of a heart attack or stroke. Time is of the essence when treating a heart attack. Typically, the sooner a heart attack or stroke is recognized and treated, the better the outcome. Many health care providers advise their patients to chew an aspirin if they believe they are having a heart attack. Chewing an adult strength aspirin may stop a blood clot from occluding a major artery, reducing the chances cardiac damage.

Treatment for non-cardiac type chest pain depends upon its etiology. For example, treating acid reflux related chest pain involves reducing the production of stomach acid with antacids or acid blocking medications. Pain related to structural pain can be relieved by taking anti-inflammatory medications, rest, and either heat or cold packs. When non-cardiac related chest pain is persistent, the cause must be determined. Diagnostic tests to determine the cause of chest pain include chest x-rays, endoscopy studies and ultrasound. A hernia may cause pain in the upper abdomen and be perceived as chest pain. Treatment for a hernia sometimes involves surgical intervention, but it depends upon the severity of the condition.

Ruling out cardiac causes of chest pain may require additional diagnostic studies. These may include an electrocardiogram, or EKG, an echocardiogram, which is an ultrasound of the heart and surround structures, a cardiac stress test. and certain blood tests. When the cardiac muscle is damaged during a heart attack, enzymes are present in the blood stream. The presences of these circulating enzymes may indicate a heart attack.