How do I know if my chest pain is serious?

 

How do I know if my chest pain is serious? Have you ever experienced chest pain? Has that chest pain made you feel that you might be having a heart attack? Do you know chest pain is not always due to heart attack?

Chest pain can be a serious symptom especially if it feels like tightness around the chest, lasts for less than 20 minutes, occurs in an obese person or someone who smokes, occurs after a physical activity or stress. Chest pain in males and those with a history of heart diseases is also considered an emergency and needs quick assessment and treatment. It is also important to know that heart attack in diabetic patients,  may not present with any symptom at all and is known as "silent myocardial infarction"

Despite the fact that chest pain, if not always,  is an important symptom of heart attack, not every chest pain is serious but the perception of association of chest pain with a heart attack is not uncommon among the general population. The good news is , a vast majority of causes of chest pain are  not fatal at all and can be treated in primary care units without any emergency. However, one cannot differentiate these causes without medical help.

In this article we'll be talking about some of the common causes of chest pain and how we can get an idea to somehow differentiate between more serious and fatal causes from the harmless ones.

 

How to define chest pain?

Epidemiology of chest pain

What causes chest pain?

Which causes of chest pain are deadly?

When should I call an EMS?

Risk factors that make a person prone to serious causes of chest pain

Diagnoses

Management

 

 

How to define chest pain?

Chest pain may be defined as any form of discomfort in the chest in which the character of pain may vary from mild burning to stabbing, crushing pain, pain which is positional i.e., changes in different positions, pain that either increases or decreases on having a meal, pain that is either local and can be pointed or is diffused around the chest and pain that makes one feel like death is approaching.

 

Epidemiology of chest pain

Around 20-40 percent of general population experience chest pain during their lifetime. Each year around 1.5 percent of the general population consult primary health care because of chest pain and chest pain is also responsible for about 40 percent of emergency admissions.

 

What causes chest pain?

Chest pain may result due to involvement of any organ located in the chest cavity or thorax including oesophagus, lungs, heart, muscles, ribs, tendons and nerves. Pain may also be radiating from back, abdomen or neck.

1. Chest pain due involvement of heart and blood vessels

A. Heart Attack

Chest pain is the most common symptom and it’s the fear of heart attack that scares people when someone has a chest pain. Heart attack needs emergent treatment else it can damage heart muscle and even cause death.

Pain associated with heart attack feels like tightness around the chest or crushing pain or "impeding death".

Chest pain due a heart attack may also be associated with other symptoms like discomfort in the arm, shoulder, or jaw, cold sweats, nausea, vomiting and shortness of breath

B. Aortic wall dissection or rupture.

Chest pain in this case is sudden and severe, present with symptoms of hypotension such as palpitation, dizziness, pale skin, loss of consciousness etc. Patient may describe the pain as "tearing" or "ripping" feeling in the chest.

 

C. Pericarditis

Inflammed pericardium, tissue that surrounds the heart, can give chest pain which is sharp, sudden. Breathing makes it more painful while sitting in an upright position reduces this pain.

 

2. Chest pain due to involvement of lungs

 

A. Pulmonary embolism

A blood clot obstructing the lung vessels can cause chest pain which has an abrupt onset and is associated with symptoms like shortness of breath, hyperventilation, palpitation, coughing up blood, low oxygen level in blood etc.

 

B. Pneumothorax

This leads to lung collapse due to abnormal leakage of air into the chest cavity usually following a trauma. It's symptoms are sudden, sharp chest pain and shortness of breath.

 

C. Pneumonia

It is the infection where air spaces in lungs get filled with pus or fluid. Chest pain in these patients is usually become worse while coughing.

 

3. Panic attack

Chest pain due to panic attack is often confused with heart attack. A close observation of other signs and symptoms such as pounding heart, light headedness, feeling of losing control, feeling of chocking, can help differentiate panic attack from a heart attack.

Chest pain due to panic attack is described as a "stabbing pain" unlike heart attack in which pain is defined as "crushing pain" or "tightness of chest".

 

4. Costochondritis

It is the inflammation of cartilage that connects ribs with sternum or breastbone. Pain increases with physical activity and on palpating the area around the sternum. Inflamed or swollen cartilages can also be seen during a physical examination.

 

5. Shingles

This infection causes a sharp, tingling pain with rash and blisters that may appear as a stripe covering a local area on the chest. It is a viral infection involving neuron and skin it innervates (dermatome).

 

6. Muscle or tendon sprain in the chest area

A sharp chest pain can be felt due to a strained or pulled muscle or tendon. Pain worsens with physical activity. Around 49 percent chest pain visits to a primary care, is an outcome of intercostals (muscles between the ribs) muscle strain.

 

7. Chest pain due to problems in the digestive system

A. Gallstones can cause chest pain that worsens following a fatty meal. Pain in this case may also radiate or can be felt between the shoulder blades. Nausea or vomiting may also be present.

 

B. Gastro esophageal reflux disease (GERD)

Chest pain in this case is defined as a "burning sensation" behind the sternum or breastbone. The person may also feel a lump in the throat, sour or bitter taste in mouth etc.

GERD comprises about 22 to 60 percent of causes of chest pain which are not related to heart (non cardiac).

 

C. Gastric ulcer

Burning pain in the chest which is felt when one is hungry. Pain reduces after eating.

 

D. Esophageal rupture

It is a rare but very fatal cause of chest pain, that in 60% of cases is due to a mistake during the medical procedure such as endoscopy, NG tube placement etc or due to forceful vomiting as in Boerhaave syndrome.

 

Which causes of chest pain are deadly?

The causes of chest pain that can kill a person if not treated on time include:

  • Heart attack
  • Aortic dissection
  • Pericarditis
  • Pneumothorax
  • Pulmonary embolism
  • Oesophageal rupture

Whenever, a person visits an emergency department for chest pain, potentially life threatening causes must be considered priority.

Other non life threatening causes are only diagnosed after a complete work up and analysis including proper history, physical examination and lab tests i.e., when the physicians are sure that it is nothing serious .

 

When should I call an EMS?

Chest pain must never be ignored and you should call for an ambulance especially if symptoms that make one suspect heart attack and other fatal causes are present. These symptoms include:

1. Sudden sensation of tightening of chest with chest pain radiating or spreading to arm, shoulder or jaw.

 

2. Cold sweats, nausea, vomiting, fast heart beat, shortness of breath.

 

3. Previous episode of same kind of chest pain which was diagnosed as heart attack.

 

4. Sudden and sharp chest pain and breathlessness especially after a long phase of lack of movement such as after a long trip or prolonged bed rest.

 

5. Sudden, sharp chest pain with reducing blood pressure, breathlessness, sweating, pale skin and loss of consciousness.

 

6. People who have a family history of heart disease, are smokers, obese, use cocaine, or are at higher risk of heart attack and thus, any chest pain in these people must be taken more seriously.

 

Chest pain that is sudden and severe must always be considered to be a result of life threatening causes that need complete work up and proper medical care.

 

Risk factors that make a person prone to serious causes of chest pain

It is important to know these risk factors for early detection and quick treatment of fatal causes of chest pain.

These risk factors are:

  • Old age
  • Smoking
  • High blood pressure
  • Diabetes
  • History of stroke
  • Family history of heart diseases, cholesterol disorders, heart attack in young age such as below 30.

 

Diagnoses

Once a person with severe chest pain is taken to emergency department, a series of process start for evaluation of the cause of pain, including complete history taking, physical examination, taking sample for lab tests etc.

Tests done to rule out the fatal causes are:

  • EKG
  • Blood tests to evaluate enzyme levels such as troponin
  • Chest x-ray to check heart, lungs and surrounding structures.
  • Echocardiogram, MRI, stress test and angiogram may also be performed for heart assessment, if needed.

 

Management

Based on the underlying cause of chest pain, the treatment methods vary from non invasive lifestyle changes, medications to invasive surgeries or combination of both.

Nitroglycerine, blood thinners such as aspirin, drugs that breakdown blood clots obstructing vessels (for example streptokinase) etc are some of the non invasive methods used to treat cardiovascular causes of chest pain including heart attack and pulmonary embolism.

Invasive procedures include implanting stent to open blocked vessel or bypass surgery.

Insertion of chest tube to remove abnormal air in the chest cavity, prescribing antacids or anti depressants etc are included in treating the non cardiac causes of chest pain.

So, even though chest pain can result from some minor conditions too, which are not life threatening, unless the deadly ones are not ruled out by medical professionals, chest pain is categorized as an emergency, which means that you need to call an ambulance if you or someone around you experiences sudden, severe chest pain.

Also it is worth mentioning that the epidemiological studies regarding the causes of chest pain have filled our lives with hopes by reducing the fear of consequences of chest pain as the most common cause of chest pain in adults are benign and easily treatable gastrointestinal problems such as GERD.

The aim of this article was to provide the reader with an insight of the diverse causes of chest pain and the importance of knowing these causes and symptoms associated with each cause, so one may remain vigilant and prevent any delay in seeking professional help while facing such situation.

 

 

 

 

 

 

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