Chest pain

Chest pain or discomfort can be a common symptom of numerous conditions related to chest wall, heart, respiratory system, gastrointestinal tract or stress and anxiety. Most of these conditions are not dangerous but the cardiac causes of chest pain can be very serious and every chest pain should be therefore carefully investigated.

Causes of chest pain


Stable angina:

A cardiac chest pain caused by impaired blood supply to the heart muscle due to narrowings or blockages in coronary arteries. Typical anginal pain feels like tightness, pressure or constriction with radiation to left arm and jaw, triggered by physical exertion or stress and relieved by rest and GTN spray.

Myocardial infarction (heart attack):

A heart attack is caused by a sudden blockage in coronary arteries supplying oxygen to the heart. If not promptly treated, the oxygen starvation can cause a damage to the heart and trigger arrhythmias (heart rhythm problems). Pain in heart attack is usually severe central chest pain radiating to arms and jaw and accompanied by sweating and breathlessness.

Pneumonia:

Lung infection caused by bacteria or viruses. Pain in pneumonia worsens on taking a deep breath and is associated with coughing, phlegm and raised temperature.

Pleurisy:

Infection of the membrane surrounding the lungs made worse by taking a deep breath in. Pleurisy is usually consequence of pneumonia. It can be very painful but responds well to simple painkillers.

Heart burn:

A symptom of gastro-oesophageal reflux disease (GORD); a burning sensation arising from your stomach all the way to your chest caused by gastric juices that leak back into oesophagus (gullet) and irritate the wall lining. As the name suggests, the pain has a burning character and typically occurs after hot and spicy meals. Heart burn can be easily mistaken for angina and heart attack due to their resemblance.

Stretched/pulled chest wall muscles:

Muscles can be strained usually after a heavy lifting, sudden movement or prolonged coughing. The diagnosis can be usually based on history and confirmed by triggering the pain on movement and deep breathing.

Anxiety and stress

Family or work related stress often causes psychosomatic symptoms, such as chest pain, inability to fully breathe in, palpitations and dizziness. Treatment may be simply rest and solution to the underlying problem but sometimes medication and psychological treatment, such as cognitive behavioural therapy, may be recommended.

When to get help?

  • The chest pain is started by physical exertion and improved by rest.
  • The chest pain has a squeezing, constricting or pressure-type character.
  • The chest pain radiates to the left arm or jaw and/or is associated with sweating, breathlessness and nausea.

When in doubt, call ambulance: better safe than sorry & in heart attack, every minute counts!

Assessing a chest pain

  • Chest pain along with nausea, sweating or breathlessness: May be a sign of heart attack or angina.
  • Chest pain while moving your upper body, with a deep breath or made worse by external pressure on the chest: Most likely not associated with heart.

What to do when someone has a chest pain?

  • Try not to panic and make the person rest.
  • Never drive if you are experiencing a chest pain, always call ambulance.
  • Loosen any tight clothing.
  • Aspirin can be given in case of emergency.
  • If a person with chest pain collapses and becomes unresponsive, call help and start immediately chest compressions (mouth to mouth breathing is not necessary).

What NOT to do?

  • Do not delay calling help, much better to raise a false alarm than miss opportunity to help.
  • Do not make the person walk or sit.
  • Never leave the person suffering from chest pain alone.
  • Do not give any medicine orally unless a medicine is aspirin/nitroglycerin.

Could it be a heart attack?

Heart attack usually involves a severe chest pain with a sensation of heavy pressure on the chest accompanied by sweating, breathlessness and fear. However, no two heart attacks are the same, the symptoms can be quite subtle, especially in diabetes and in elderly people. Sometimes heart attack may have no symptoms at all (= silent heart attack) and will be diagnosed only retrospectively on ECG (electrocardiogram) or echocardiogram (heart ultrasound scan).

Risk factors for coronary artery disease and heart attack

  • Smoking.
  • High blood pressure
  • High cholesterol
  • Obesity and physical inactivity
  • Family history of coronary artery disease
  • Age and male gender

Tests for diagnostics of chest pain

Most important is a careful history and physical examination. The tests that can help are:

  • ECG (electrocardiogram)
  • Blood tests (troponin)
  • CXR (chest x-ray)