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Chest pain

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

Considerations

Many people with chest pain fear a heart attack. However, there are many possible causes of chest pain. Some causes are mildly inconvenient, while other causes are serious, 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.

Angina is a type of heart-related chest pain. This pain occurs because your heart is not getting enough blood and oxygen. Angina pain can be similar to the pain of a heart attack.

Angina is called stable angina when your chest pain begins at a predictable level of activity. (For example, when you walk up a steep hill.) However, if your chest pain happens unexpectedly after light activity or occurs at rest, this is called unstable angina. This is a more dangerous form of angina and you need to be seen in an emergency room right away.

Causes

Other causes of chest pain include:

• Asthma, which is generally accompanied by shortness of breath, wheezing, or cough.
• Pneumonia, a blood clot to the lung (pulmonary embolism), the collapse of a small area of a lung (pneumothorax), or inflammation of the lining around the lung (pleurisy). In these cases, the chest pain often worsens when you take a deep breath or cough and usually feels sharp.
• Strain or inflammation of the muscles and tendons between the ribs.
• Anxiety and rapid breathing.

Chest pain can also be related to problems with your digestive system. These include stomach ulcer, gallbladder disease, gallstones, indigestion, heartburn, or gastroesophageal reflux (when acid from your stomach backs up into your esophagus).

Ulcer pain burns if your stomach is empty and feels better with food. Gallbladder pain often gets worse after a meal, especially a fatty meal.

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

Home Care

If injury, over-exertion, 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 the instructions of your doctor and take your medications regularly to avoid flare-ups.

When to Contact a Medical Professional

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.
• Chest wall pain persists for longer than 3 to 5 days.

What to Expect at Your Office Visit

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 breastbone? 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, bending?
• When you are exercising? Is the pain 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
• 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 second-hand smoke.
• Eat a diet low in saturated and hydrogenated fats and cholesterol, and high in starches, fiber, fruits, and vegetables.
• Get at least 30 minutes of moderate intensity exercise on most days of the week.
• Reduce stress.

References

Altman EM, Smith SC Jr., Alpert JS, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation. 2004;110:588-636.

Braunwald E, Artman EM, Beasley JW, 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). Journal of the American College of Cardiology. 2000;36(3):970-1062.

Smith SD Jr., Blair SN, Bonow RD, et al. AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients with Atherosclerotic Cardiovascular Disease: 2001 Update: A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology. Circulation. 2001;104:1577-1759.

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