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Chest Pain

Definition


Disease: Chest Pain Chest Pain
Category: Other Diseases
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Disease Definition:

One of the most common reasons people call for emergency medical help is chest pain, which can come suddenly at any time. Though it may be scary, but chest pain usually doesn’t have anything to do with a heart problem. Emergency room doctors evaluate and treat millions of people for chest pain every year.

The problem may still be important, and worth the time spent in an emergency room for evaluation, even if the chest pain has nothing to do with his/her cardiovascular system.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Though there is no easy way to tell without seeing a doctor, in most cases the underlying cause of chest pain has nothing to do with the heart. Chest pain can be caused by a wide range of health problems.

Chest pain related to non-cardiac problems:
The following are more often associated with chest pain that is not related to a heart problem:

  • Pain that intensifies when breathing deeply or coughing
  • A sour taste or a sensation of food re-entering the mouth
  • Tenderness when pushing on the chest
  • Trouble swallowing
  • Pain that gets better or worse when changing body position
  • A burning sensation behind the breastbone (sternum)


Chest pain related to cardiac problems:
One or more of the following is/are usually associated with chest pain related to a heart attack or other heart problems:

  • Pain that lasts more than a few minutes, goes away and comes back or varies in intensity
  • Pressure, tightness or fullness in the chest
  • Shortness of breath, dizziness, nausea or sweating
  • Crushing or searing pain that radiates to the back, jaw, arms, shoulders and neck, the left arm in particular.


Emergency medical help should be called immediately when someone is having new or unexplained chest pain. Time shouldn't be wasted in trying to diagnose heart attack symptoms by the patient himself/herself. Because when a person is having a heart attack, every single minute is crucial.

No one should drive a car when having a heart attack, because it puts them and others at risk of harm. Only when there’s no one around who could drive to the hospital should the patient drive the car.

Causes:

All of the causes of chest pain deserve medical attention.

RESPIRATORY CAUSES:

Pleurisy:
When the membrane that lines the chest cavity and covers the lungs becomes inflamed, this sharp, localized chest pain occurs, which becomes worse when inhaling or coughing. A wide variety of underlying conditions including pneumonia and, in rare cases, autoimmune conditions such as lupus, may cause pleurisy. Autoimmune diseases are those in which the body’s immune system mistakenly attacks healthy tissue.

Pulmonary embolism:
Chest pain may also occur when a blood clot becomes lodged in a lung (pulmonary) artery, blocking blood flow to lung tissue. Immobilization and recent surgery are preceding risk factors without which it's rare for this life-threatening condition to occur.

Other lung conditions:
Chest pain can be caused by high blood pressure in the arteries carrying blood to the lungs (pulmonary hypertension), asthma and a collapsed lung (pneumothorax).

CARDIAC CAUSES:

Pericarditis:
This condition is often related to a viral infection and is short-lived. It is an inflammation of the sac surrounding the heart.

Aortic dissection:
The aorta, which is the main artery leading from the heart, is involved in this life-threatening condition. Sudden and tearing chest and back pain will result if the inner layers of this blood vessel separate and force blood flow between them. A sharp blow to the chest may cause aortic dissection, or it may develop as a complication of uncontrolled high blood pressure.

Heart attack:
A blood clot that blocks blood flow to the heart muscle can cause a heart attack.

Angina:
On the inner walls of the arteries that carry blood to the heart; hard, thick and cholesterol-containing plaques can gradually build up. During exertion in particular, these plaques temporarily narrow the arteries and restrict the heart's blood supply. Recurrent episodes of chest pain, angina, or angina pectoris can be caused by restricted blood flow to the heart.

Coronary spasm:
In coronary spasm, arteries that supply blood to the heart go into spasm, temporarily stopping blood flow. This condition, which is sometimes called Prinzmetal's angina, may coexist with coronary artery disease, which is a buildup of plaques in the coronary arteries, which occurs at rest.

Other heart-related conditions:
Chest pain can be caused by other heart problems, like myocarditis, which is an inflammation of the heart that is often caused by a viral infection. Chest pain can also be caused by certain types of heart muscle disorders, such as hypertrophic cardiomyopathy.

MUSCULOSKELETAL CAUSES:

Injured ribs or pinched nerves:
Chest pain can be caused by a pinched nerve, as well as a bruised or broken rib.

Costochondritis:
Chest pain will result if the cartilage of the rib cage, which is the cartilage that joins the ribs to the breastbone in particular, becomes inflamed. And when one pushes on his/her sternum or on the ribs near the sternum, the chest pain often worsens. This condition is also called Tietze syndrome.

Sore muscles:
Persistent muscle-related chest pain may be caused by chronic pain syndromes, such as fibromyalgia.

DIGESTIVE CAUSES:

Gallbladder or pancreas problems:
Acute abdominal pain that radiates to the chest can be caused by gallstones or inflammation of the gallbladder (cholecystitis) or pancreas.

Heartburn:
It is a painful, burning sensation behind the breastbone (sternum). It’s caused when stomach acid washes up from the stomach into the esophagus that runs from the throat to the stomach.

Achalasia:  
In this swallowing condition, food backs up into the esophagus causing pain instead of the normal case in which the valve in the lower esophagus opens properly allowing food to enter the stomach.

Hiatal hernia:
Heart burn, as well as chest pain or pressure, after eating in particular, is caused by this condition, which occurs when part of the stomach slides up above the diaphragm into the chest.

Esophageal spasm:
Swallowing may become difficult and even painful because of disorders of the esophagus, the tube that runs from the throat to the stomach. Esophageal spasm, a condition that affects a small group of people with chest pain is one type of those disorders. Painful muscle spasms are caused by this condition when swallowing, because the muscles that usually move food down the esophagus are uncoordinated.

OTHER CAUSES:

Cancer:
Chest pain can be, in rare cases, caused by cancer involving the chest or cancer that has spread from another part of the body.

Panic attack:
A person may be experiencing a panic attack, which is a form of anxiety, when experiencing periods of intense fear accompanied by shortness of breath, rapid breathing (hyperventilation), chest pain, rapid heartbeat and profuse sweating.

Shingles:
The chickenpox virus causes shingles, an infection of the nerves. Pain and a band of blisters from the back around to the chest may result from this condition.

Complications

Complications:

None

Treatments:

TREATMENT OF CHEST PAIN CAUSED BY NON-CARDIAC CONDITIONS:
For further evaluation, the patient may be referred to his/her own physician or a specialist once the emergency room doctors determine he/she is out of immediate danger. The type of the problem determines the treatments for non-cardiac causes of chest pain. Here are some problems and their treatments:

Shingles:
It's better to start treatment with acyclovir or a similar antiviral medication as quickly as possible, within 24 hours from the onset of pain or burning if it's possible, and before the appearance of blisters. To control symptoms such as itching and pain. Other treatments are used, such as antihistamines and analgesics.

Costochondritis:
Heat, rest and taking nonsteroidal anti-inflammatory drugs such as ibuprofen are usually the best that can be done to treat this inflammation of the cartilage of the rib cage.

Pleurisy:
A variety of conditions, which include pneumonia and, in rare cases, autoimmune conditions such as lupus, can be the cause of this inflammation of the pleura, which is the membrane that lines the chest cavity and covers the lungs. Until the inflammation subsides, the pain may be minimized by the help of over-the-counter pain relievers. The doctor may want to identify and treat the underlying disease that caused pleurisy.

Injured ribs, pinched nerves or sore muscles:
With time and self-care measures recommended by the doctor, chest pain from sore chest muscles, injured ribs and pinched nerves can improve.  

Gallbladder or pancreas problems:
To treat an inflamed gallbladder or pancreas that's causing pain to radiate from the abdomen into the chest, surgery may be needed.

Swallowing disorders:
The causes of these disorders, which are many, can be generally treated with endoscopic techniques, medications or minor surgery. For evaluation and treatment, the patient is likely to be referred to a gastroenterologist.

Heartburn:
One will likely need to take an over-the-counter or prescription-strength stomach acid blocker or antacid in the emergency room if the symptoms suggest heartburn. Overeating or eating fatty foods is the cause of most episodes of heartburn, which are isolated events.

The patient may be asked to undergo more tests by his/her doctor or a doctor who specializes in stomach and intestinal problems (gastroenterologist), in case the patient experiences frequent heartburn, at least one episode a week. Narrowing and scarring of the esophagus may be caused by chronic, frequent heartburn when leaving this condition untreated. Antacids, dietary modifications, acid blockers or other prescription medications and sometimes surgery may be included in the treatment for chronic heartburn.

Panic attack:
Counseling to find out the cause of the attacks, relaxation techniques and anti-anxiety medications can treat this anxiety-related cause of chest pain. Many people go to emergency rooms for panic attacks, as this problem is often mistaken for a heart attack. However, to help the patient gain control over these attacks, he/she can be referred for treatment once the condition is diagnosed.

TREATMENT OF CHEST PAIN CAUSED BY CARDIAC CONDITIONS:
The following medications may be given when it seems heart problems are the cause of the chest pain:

Calcium channel blockers:
To relax the coronary arteries and prevent spasm, heart medications such as calcium channel blockers may be used when treating coronary artery spasm.

Thrombolytics:
A blood clot that's blocking blood flow to the heart may dissolve with the help of these drugs, which are also called clotbusters. When taken within an hour after symptoms of a heart attack, these drugs are most effective.

Beta blockers:
Decreasing the demand on the heart, these medications help decrease blood pressure, slow the heart rate and relax the heart muscle. A second heart attack may be prevented and the amount of damage during a heart attack may be limited with the help of these drugs.

Aspirin:
By helping to maintain blood flow through narrowed heart arteries, aspirin inhibits blood clotting. This medication can significantly decrease death rates when it is taken during a heart attack. To hasten its absorption, the aspirin should be chewed. For most people who have had a heart attack, taking aspirin is recommended.

Ranolazine:
This is a relatively new drug that treats chronic angina. Because it can cause a heart problem known as QT prolongation, which can increase one's risk of heart rhythm problems, this drug is only used when other anti-anginal drugs haven't worked. Nitroglycerin, beta blockers and calcium channel blockers are other angina medications with which this drug should be used.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs):
Blood can flow from the heart more easily with the help of these drugs. A person who has had a moderated to severe heart attack that has reduced one's heart's pumping capacity may be prescribed ACE inhibitors or ARBs. Blood pressure may become lower and a second heart attack may be prevented with the help of these drugs.

Nitroglycerin:
Improving the blood flow to and from the heart, this medication that treats angina temporarily widens narrowed blood vessels.

TREATMENTS FOR HEART ATTACK:

When it’s absolutely clear that a person is having a heart attack, he/she may be treated with clotbusting drugs or undergo a surgical procedure such as the following:

Coronary bypass surgery:
An alternative route is created in this procedure, so that blood could go around a blocked coronary artery.

Angioplasty and stenting:
A catheter with a special balloon is inserted into a blocked coronary artery during an angioplasty, also called a percutaneous coronary intervention (PCI). The balloon is inflated to open up the artery and restore blood flow to the heart of the patient, and a small wire mesh coil (stent) is usually inserted to keep the artery open. Having angioplasty as quickly as possible is important, which is why many people go straight from the emergency room to the catheterization laboratory.


TREATMENTS FOR ANGINA:


The first line of treatment for angina is medications. Anticoagulants, nitroglycerin, beta blockers and aspirin are examples of these medications, which the patient starts taking while in the emergency room.
The patient may need immediate coronary catheterization followed by angioplasty and stenting when having unstable angina, which is chest pain while resting. Sometimes, coronary bypass surgery may also be needed.  

TREATMENTS FOR OTHER CARDIOVASCULAR CONDITIONS:


In the emergency room, other heart and lung conditions are initially treated. The patient will likely be treated with emergency blood-thinning medications, which include clotbusting medications (thrombolytics) in some cases, if it's clear that the patient is experiencing a pulmonary embolism. Emergency surgery is often required in the case of aortic dissection.

Prognosis:

Not Available

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