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Chest Pain

Overview

Chest pain should never be overlooked as it is frequently linked to the heart. However, you must be aware that there are numerous alternative causes. Chest pain can be caused by various things, including troubles with your lungs, esophagus, muscles, ribcage, or nerves. Several of these illnesses are dangerous and life-threatening. Others, though, are not. If you're experiencing unusual chest pain, the only thing to locate what's causing it is to see a doctor. Chest pain can be sharp,  stabbing, dull, burning, or aching. Heart and lungs involvement can signal a major problem; therefore, it's critical to get urgent treatment right away.

Causes

There are numerous causes of chest pain. Most of the time, chest pain is caused by anything other than heart disease. It is always better to see a doctor instead of self-diagnosing if you're concerned.

The following are the most frequent causes of chest pain:

Chest pain due to digestive tract involvement:

  • Acid reflux disease:  severe, burning sensation in front of the chest
  • Esophageal disorders: Swallowing can be hard and even unpleasant
  • Gall bladder stones or pancreatic problems

Chest pain due to bone or muscle involvement:

  • Costochondritis: painfully inflamed rib cage.
  • Muscle disorders such as fibromyalgia or chronic muscle soreness.
  • Trauma to the chest results in a broken rib or muscle injury.
  • Stress-induced 

Chest pain due to heart involvement:

  • Pericarditis: it is inflammation of the membrane around the heart. It is characterized by a rapid, intense, shooting pain that worsens when you take deep breaths or stay in bed.
  • Angina or a heart attack share the same clinical manifestations, associated with nausea, vomiting, diaphoresis, and it can be fatal. Risk factors include smoking, age, hypertension, diabetes, high cholesterol, obesity, or having a family history of heart problems  in people under the age of 60
  • Myocarditis. It is the inflammation of muscles of the heart
  • Hypertrophic Cardiomyopathy. The cardiac muscle thickens abnormally due to hereditary factors.
  • Mitral valve prolapse occurs when one of the heart's valves fails to shut properly.

Chest pain due to lung involvement:

  • Pleuritis.  Irritation of the lungs lining.
  • Lung abscess or pneumonia: when there is a lung infection
  • A pulmonary embolism: A condition in which a blood clot moves through the circulation and lodges into the lungs.

Epidemiology

Chest pain is a frequent complaint that affects 20 to 40% of the general public at some point in their lives. About 1.5 percent of citizens visit a primary care doctor with chest discomfort symptoms each year. 

Signs And Symptoms

You may experience various symptoms in addition to chest pain.

Symptoms related to heart disease

Although chest pain is the most prevalent symptom of cardiac disease, some individuals suffer additional symptoms. Atypical symptoms, particularly in women, maybe reported and later be identified as the outcome of a heart problem:

  • heavy feeling in the chest
  • fatigue 
  • sweating
  • pain in the back or arms
  • jaw pain
  • dizziness
  • upper abdominal pain
  • nausea, vomiting
  • pain that increases on exertion

Other signs and symptoms

  • Indications that your chest pain isn't caused by your heart are as follow:
  • Acidic flavor in the mouth
  • painful swallowing
  • pain increase or decrease on the movement of your body
  • Pain that gets worse after you cough or breath.
  • chest pain with a skin rash
  • high body temperature, aches, shivering
  • a stuffy nose, cough
  • anxiety
  • fast breathing.

Diagnosis

After taking a detailed history and physical examination, your doctor may advise you to undergo one or more of the following tests to confirm the chest pain. 

Electrocardiogram: The heart’s electrical activity is measured in this fast procedure. Adhesive plugs (electrodes) are applied to the chest and the arms and legs in some cases. The electrodes are connected to a computer through wires, which shows findings. An Electrocardiogram can reveal whether the heart is beating excessively quickly, slowly, or not at all. The ECG may suggest that you've had or are experiencing a heart attack because wounded muscle tissue doesn't conduct electrical signals in a regular pattern.

Cardiac enzymes: Increased amounts of specific proteins or enzymes found in cardiac muscle may be detected by blood testing. Injury to cardiac tissue caused by a heart attack may enable these proteins or enzymes to escape into the bloodstream over several hours.

X-ray of the chest: A chest X-ray can reveal the lungs’ state and the size and form of the heart and main blood channels. A chest X-ray can also show lung disorders such as pneumonia or a collapsed lung.

CT scan of the chest: CT scans can identify an aortic dissection or a large blockage in the lung (pulmonary embolism).

Stress tests: These tests are performed to check your heart’s response to find out if the chest pain you are having is due to heart disease or not. 

Coronary catheterization: Coronary catheterization is a procedure that involves inserting a catheter into the coronary artery. This procedure allows doctors to see any obstructions in the heart vessels. A catheter is a long, narrow, flexible tube placed into a blood channel and directed to the heart, generally in the pelvis or forearm. Dye is delivered to the heart vessels via the catheter. The dye makes X-ray video and photos show the arteries more effectively. This test is also known as coronary angiogram.

Treatment

Treatment for chest pain differs based on the cause. These are some medications used to treat chest pain caused by the heart.

Nitroglycerin: This allows blood to flow more freely through the restricted gaps and relaxes the arteries.

Aspirin: If your chest pain is thought to be linked to your heart, you'll most likely be prescribed aspirin.

Thrombolytic medications: These medications remove the clot that prevents blood from flowing to the heart muscle.

Blood thinners are drugs that thin the blood. If you have a blockage in an artery that feeds your heart or lungs, you'll almost certainly be prescribed anticoagulant medicines to stop future clots formation.

Other medicines:

Medication that reduces acidity:  If stomach acid is splashing into the esophagus and causing chest pain, your practitioner may recommend drugs to lessen the number of stomach acids like proton pump inhibitors (omeprazole) or H2 blockers (ranitidine)

Medications for stress or panic disorder: If you have a panic disorder, your doctor may recommend antidepressants (SSRIs, TCAs, etc.) to help you manage your symptoms. It's also possible that talk treatment, such as cognitive therapy, will be advised.

Procedure

Angioplasty: This is the most common treatment for chest pain due to an obstruction in a heart artery. A catheter with a balloon on the tip is inserted into a big blood channel, generally in the pelvis, and guided to the obstruction. The balloon is inflated to expand the vessel, then deflated, and the catheter is removed. A tiny stent is frequently kept outside of the catheter's balloon tip. The stent expands and seals into position, keeping the artery intact.

Bypass surgery: It is a procedure that involves the removal of a portion of a blood vessel from some other body part to establish a passage for blood to bypass the clogged artery.

Prognosis

Since various drugs work effectively for chest pain (both cardiovascular and non-cardiac), the outlook of chest pain is usually positive. However, the person's overall outlook is determined by the underlying reason for the chest pain. The prognosis for cardiac and non-cardiac chest discomfort is moderate to bad if the underlying cause is not treated.

Lifestyle Modifications

  • People who try not to smoke and follow a healthy living that includes low-fat foods, fiber, and activity may avoid cardiac chest pain. Individuals with risks for heart illness can lower their likelihood of developing the disease and the resulting chest pain by following their doctor's instructions and taking the prescribed medication.
  • Pain that is other than cardiac pain can be avoided if the underlying factors of pain are addressed. It can be avoided by eliminating factors that raise your chance of pneumonia, sore muscles, or chest injury.