Chest pain- Chest pain Types and Causes

Have you or one of your kinfolks recently experienced an episode of chest pain? Or are you here for an educational purpose? Whatever the reason you are here, we on this site give you reliable factors on important health topics in a simpler manner. So, in this article, we will give you an insight into Chest pain. As soon as someone experiences chest pain, they are very afraid, thinking this may be the end of their life. The very thing that comes to mind is “My time has come.” While there’s no wrong in thinking that manner, let’s dig more into this topic to know how it relates to our health.

Chest pain can be defined as pain or discomfort in any area of your chest. Different people describe this pain in different ways.

• Someone says they feel this as a tightening type.
• For another, it’s like aching
• for another, it’s just a burning sensation
• for another, it’s just a stabbing type.
• Someone feel like their chest is being crushed or squeezed.

So, whatever the type it is, there are many more to analyze before coming to a conclusion. All these things said by the person who experienced this pain have a value for a proper diagnosis later during the management.

While central chest pain is the most common symptom associated with heart disease, diseases in diverse other systems can also manifest chest pain. Therefore, it is very important to establish a good analysis of the symptoms to exclude various differential diagnoses.

Different causes of chest pain

1. Cardiac causes:- Ischemic heart disease, pericarditis, aortic dissection
2. Respiratory causes:-pneumonia, pulmonary embolism, pneumothorax
3. GIT-associated causes (gastric causes):-Gastroesophageal Reflux Disease (GORD), esophageal spasm
4. Neurological causes
5. Musculoskeletal causes

Also, chest pain is a common symptom of Covid-19, especially due to respiratory causes. Even certain patients continue to have chest pain after covid initial infection.

Once a person is presented with Chest pain, a doctor usually digs deep and asks more questions from you to arrive at a specific diagnosis. So if you are a patient with chest pain, cooperate with the doctor and help him analyze your chest pain symptoms by giving the answers to relevant questions asked by him/her. There is a high probability of having the below-given list of particulars among those questions. For medical students, here with us, this is how you need to describe the presenting complaint during history (Hx) taking.

• Site of the chest pain ( Eg: Retrosternal/ Pain in the middle of the chest/ Chest Pain left side/ Chest Pain right side)
• Onset (Gradual/Sudden)
• Nature/Character of the pain (Eg: Tightening, squeezing, Chest pain that comes and goes )
• Duration (<20 min, >20 min)
• Severity (Gradation based on patient’s perception)
• Radiation of the pain (Left arm, neck, jaw…)
• Associated symptoms ( Sweating, Shortness of Breath, Syncope, Palpitations, Vomiting, Faintishness, Nausea, Chest Pain when breathing…)
• Aggregating factors (Chest pain after eating heavy meals, Physical Exercise, Weather changes, Stress)
• Relieving factors (Drugs like GTN, Resting, Lying Down)

Sometimes there may be slight differences in showing these chest pain symptoms among men and women. For example, chest pain caused in females makes her experience fatigue, nausea, and dizziness, unlike in males. Also, chest pain radiates to both upper limbs in them.

What causes chest pain

1. Chest pain due to respiratory causes.

i. Pain caused by Pleuritis

There is a pleuritic type of chest pain localized in sharp pain in respiratory diseases. Usually, this aggravates by deep breathing and coughing. People explain this as “they have chest pain when inhaling.” This is a typical feature of pleuritis caused by inflammation or irritation of the outer lining of the lungs and chest.

ii. Pain caused by Chronic costochondritis

Chronic costochondritis is characterized by localized anterior chest pain. Tenderness over the costochondral junction is another important sign of Chronic costochondritis. Costochondritis happens basically due to the inflammation over the regions where ribs join with the cartilage. Usually, anti-inflammatory drugs work well in these conditions.

iii. Pain caused by Tracheitis

Tracheitis may associate with retrosternal soreness. Malignant invasion of the chest pain may lead to a constant, severe, and dull chest pain.

iv. Pain caused by Pneumonia

If we further analyze chest pain in the respiratory system, we can arrive at much more diagnoses. There is a pleuritic type chest pain associated with shortness of breath, fever, wheezing, productive cough, and hemoptysis in pneumonia.

v. Pain caused by Pulmonary embolism

Pulmonary embolism can also result in pleuritic chest pain. This pain is sudden in onset. If large emboli are present, they present with syncopal and pre-syncopal episodes. Associated symptoms include tachypnoea and hemoptysis. In these patients, paying attention to risk factors like long-term immobilization and history of DVT is important.

vi. Pain caused by Pneumothorax

Pneumothorax may present with pleuritic chest pain that worsens with the shortness of breath.

2. Chest pain associated with the Cardiovascular system

i. Pain caused by Myocardial hypoxia or reduced O2 supply to the myocardium of the heart

Central chest pain is a common symptom of heart disease. Myocardial hypoxia or reduced O2 supply to the myocardium of the heart is associated with the pain of angina pectoris and myocardial infarction or heart attack.

The classical features of cardiac chest pain, especially in ischemic heart disease like angina pectoris, are central in location and radiate to the neck, jaw, or upper limbs. Also, autonomic symptoms like nausea, vomiting, and regurgitation can be presented with chest pain. Most of these patients either have similar episodes in the past or have risk factors for coronary artery disease.

Angina pectoris

Angina pectoris is a pain that occurred when the blood supply does not satisfy the metabolic demand. This causes ischemic pain and results in other ischemic abnormalities as well.

As angina pectoris is a very common incident, it is better to share some epidemiology factors with you. The prevalence of angina pectoris increases with age in both males and females. 10% -12% among females aged 65 – 84 years and 12% – 14% among males of the same age group. This shows that the prevalence of angina pectoris is high in males than in females. The mortality rate due to stable angina varies from 1.2% – to 2.4%. However, the prognosis of stable angina is very good. But for that, lifestyle modification is admiringly vital.

For the management of stable angina pectoris, interventions can be done through medical therapy. Also, revascularization by percutaneous coronary intervention is commonly used in managing angina pectoris, which is associated with chest pain.

ii. Pain caused by Pericarditis

If the chest pain is central in location, has a sharp nature, and has a pleuritic quality, it is more suggestive of pericarditis. The character of the pain is usually diffuse stabbing type which exacerbates with deep breathing and movements. Associated symptoms of this sharp chest pain include dyspnea (SOB) as well. Most patients relieve this type of chest pain by leaning forward.

iii. Pain caused by Aortic dissection

Aortic dissection presents as instantaneous severe tearing-type chest pain. This is also chest pain in the middle. Typically this chest pain radiates to the arm and back. The associated symptoms include dizziness, numbness, pain, and coldness of the arm. Also, some patients experience a transient weakness of the part of the body.

3. Chest pain associated with gastric problem

In GORD, there is a retrosternal burning pain which increases at night and by bending forward. It presents with belching, burping, heartburn, and regurgitation of food. Laryngeal irritation that comes subsequently in this condition can cause cough. Dairy products, fatty meals, coffee, chocolates, smoking, alcohol, and NSAIDs are the risk factors for this condition.

4. Neurological Chest pain

It presents as a band-like sensation of spreading chest pain. This might be due to the involvement of the thoracic nerve root.

Anxiety, depression, family problems, and other social problems in a particular patient may elicit a psychological type of chest pain.

5. Chest pain associated with the Musculoskeletal system

This has a history of trauma, exercise, and fever. Deep breathing, movements, and touching increase this pain. This pain is usually localized and alters with movement.

Investigations

The history taking and examination that the doctor does are very important to arrive at a diagnosis or differential diagnosis. So to confirm or exclude the diagnosis, certain investigations are done. Such investigations are important in further management of the patient as well.

1. ECG (Electrocardiography)

ECG is primarily done in many instances of chest pain. We can gather much information regarding the patient through this. Especially it comes handier in chest pain due to cardiovascular diseases. ECG is a recording of the electrical activity of the heart.

2. Blood tests

These are also important for arriving diagnosis. These blood investigations include various markers specific to diseases, routine hematology tests, urea/creatinine, electrolytes, liver biochemistry, enzymes, BNP, and thyroid function tests.

3. Imaging modalities like chest x-rays

They give additional information to the diagnosis. Echocardiography, nuclear imaging, computed tomography (CT), coronary angiography, cardiovascular magnetic resonance (CMR), positron emission tomography (PET), and cardiac catheterization are some other tests that are done according to the need. It is important to consider the patients’ income before requesting these tests because some of them are highly expensive.

Treatments

Patients with chest pain symptoms come to the ward in a varied manner. Saving of life of these patients is the doctor’s priority. Therefore, doctors start managing these patients by giving them advanced life support (ABCD). Then management and treatment commenced by starting drug therapy and other relevant investigations. Coming into an early diagnosis is vital as Chest pain Causes are different, so their management is different.

A German researcher said chest pain relief exercise is more effective than percutaneous interventions like stents. If you want your chest pain to go away, exercising at least 20 minutes per day and the medication for the underlying cause is highly recommended. Aerobic exercises like running, swimming, cycling, jumping rope, and brisk walking are some examples of chest pain relief exercises.

Chest pain Emergency

Almost every kind of chest pain is not an emergency. But still, chest pain is not something you need to wait at home till it gets reduced. Severe chest pains suggestive of Myocardial infarction need to get immediate action. If not, the patient can die from it. Unstable angina likewise has a similar significance. Aortic dissection where the pain radiates to the back is of utmost importance. As a patient, you should not take a risk by staying at home if you get such severe pain.

When to see a doctor?

If you are experiencing new or unexplainable chest pain, you must consult a doctor as soon as possible. Better call an emergency service. If not, make sure to go to the hospital with a bystander.

Complications of chest pain

Always there is a pathology behind any kind of chest pain. Therefore, taking medical advice is always good to reduce future complications. Especially chest pain is a kind of warning sign of a heart attack. The longer such condition is left untreated, the more damage it causes. Ultimately these patients die from MI. Also, in other non-cardiac-related conditions, day by day, more complications develop in them if left untreated or if the patients’ compliance with the treatment becomes reduced.

Chest Pain in pregnancy

Chest pain during pregnancy can be innocuous because the body adjusts throughout the pregnancy. The expansion of the uterus pressurizes the diaphragm. Also, the uterus pushes organs in the chest cavity, breasts become larger, and the ribcage becomes widens. So these changes cause pressure and heartburn that manifest as chest pain.

But you should not always ignore the chest pain during pregnancy as it may indicate more severe conditions like heart attack and pre-eclampsia. These are emergencies where you need to seek medical advice as soon as possible.

Angina quitting smoking person has a mental status as same as the mental status of a person who has never smoked. So they can easily quit smoking angina because they already have had bad angina experiences. Angina quitting smoking improves angina along with the quality of life.