TYPES OF CHEST PAIN – NOT ALWAYS A HEART ATTACK!

·         NON CARDIAC CHEST PAIN

Both young and old, have intermittent chest pain. Chest pain can be alarming, as it might indicate severe heart disease or even a heart attack. However, many people (and most young people) have chest pain that is not caused by the heart- this is called non-cardiac chest pain. The most common cause of non-cardiac chest pain arises from a nearby organ, the esophagus (food pipe) Esophageal causes of non cardiac chest pain include gastroesco-pahageal reflux disease (GERD) and esophageal spasm. GERD results from stomach acid backing up into the esophagus, which produces heartburn and chest pain. Esophageal spasm is caused by chaotic muscle contractions of the lower esophagus aggravated by acid reflux, stress or unknown factors. Another common cause of no cardiac chest pain is musculoskeletal problems, especially fibromyositis (muscle inflammation). Finally, anxiety and panic attacks can produce chest pain that resembles the pain experienced during a heart attack. The chest pain is usually in the middle of the chest and is characterized by a dull, burning or pressure sensation. The pain usually does not radiate into the neck, shoulders or arms. Non cardiac chest pain secondary to esophageal causes is made worse during or after meals, when lying on the back (supine position), exercising or when experiencing anxiety. Associated symptoms are often found including heartburn, acid regurgitation or difficulty swallowing and a feeling of food sticking in the middle of the chest (dysphagia). Non cardiac chest pain secondary to musculoskeletal disorders can be located anywhere on the chest wall(multiple painful sites are common). Patients may also complain of muscle and joint aches, fatigue and difficulty sleeping. The chest pain associated with anxiety and panic attacks is accompanied by a feeling of impeding doom, shortness of breath, heart palpitations, sweating and insomnia. Most patients can have complete relief of their symptoms if the appropriate cause of non cardiac chest pain is identified.

 

·         GASTROINTESTINAL CAUSES – THE DIGESTIVE TRACT

“Usually burring in nature, this pain gets relieved with antacids like digene.”

 

Pains originating from the digestive tract often can mimic heart pains. Acid produced in the stomach can sometimes reflux, or back up into the esophagus, the long tube that connects the mouth to the stomach. This can cause discomfort in the upper stomach or around the breastbone. Acid reflux can irritate and inflame the esophagus, a condition known as esophagitis. It occurs after a meal or when one lies down. One clue that acid reflux may be the cause of chest pain is that the discomfort often is relieved by the use of an antacid such as Digene.

Another cause of pain originating from the digestive tract is an ulcer , an erosion of the lining of the stomach or duodenum, the first part of the small intestine. Ulcers can result from heavy alcohol consumption, chronic use of nonsteroidal anti-inflammatory agents (NSAIDs), and pain medications, such as ibuprofen. Ulcers may also develop without a clear cause. As with acid reflux, the ulcer pain can cause discomfort in the upper abdomen, can be triggered by eating, and is sometimes relived with antacids.

 

·         MUSCULOSKELETAL CAUSES

The chest contains many muscles, bones, tendons and cartilage (the rubbery tissue that connects muscles and bones). Strains or sprains to any of these can cause chest pains. Chest pains associated with musculoskeletal injury are typically sharp and confined to a specific area of the chest. They may be brought on by movement of the chest and arms into certain positions, and often are relieved by changing position. These pains can be triggered by pushing on part of the chest and often becomes worse when taking a deep breath. These pains usually lasts one seconds , but can persist for days.

 

Costochondritis: Our lungs are protected by a bony cage called the rib cage. This rib cage also gives the shape of to our chest. The ribs are joined to a central bone over the chest called the sternum or the breast bone. The joint between these two bones is intervened by a soft bone like structure called the cartilage. Inflammation of these cartilages lead to acute pain over the chest and the condition is called costochondritis. The pain of chostochonritis aggravates with pressure over the inflamed bone. It is manifested by painful swelling of one or more costochondral joints. The onset of pain may be sudden or gradual. The pain may radiate to the arms or shoulder and is aggravated by sneezing, coughing, deep breathing, or twisting motion of the chest. Analgesics, anti inflammatory drugs and local steroid injections usually relieve the symptoms. Other skeletal causes of chest pain are fracture of rib , inflammation of the breast bone etc. they are easily distinguishable by X rays.

 

Arthritis of the shoulder: it is inflammation of the shoulder joint. This can result in acute pain of the arms and can easily mimic the radiating chest pain of heart. Unlike the angina pain this pain will get aggravated with shoulder movements and movements of arms.

 

CAUSES IN THE LUNGS

 

Pneumonia is an infection that develops in the lungs it can lead to inflammation of the lung tissue or the tissue that surrounds the lung, a condition called pleurities are often made worse by deep breaths or coughing.

 

A rare but life threatening condition that affects the lungs is pulmonary embolism, a blood clot that develops in the vein in the pelvis or legs. If part of the clot breaks free, it can travel through the bloodstream and into the lungs, where it may block the flow of blood in part of the lung.  This can cause sudden chest pains and shortness of breath.

Bronchitis is another condition which can cause chest pain. Since bronchitis is associated with infection and smoking the pain is usually a constant ache which is associated with coughing and fever.

 

AORTIC DISSECTION

 

A rare but often fatal condition associated with chest pain occurs when a tear develops in the wall of the aorta (the large blood vessel that carries blood from the heart to the head, arms, chest, abdomen and legs). This condition called aortic d section, causes severe pain in the chest and back. Often described survivors as the word pain they ever experienced the pin of aorta dissection may last hours even days. Although occurs most commonly in patients with high blood pressure aortic dissection can strike anyone. It is a life threatening condition that requires immediate diagnosis and treatment. The aorta is the largest artery in the body and is directly attached to the heart. The aorta and its branches carry all the blood from the heart out to the rest of the body. When there is a weakening of the wall of the aorta for any reason, blood flow can cause a tear in the wall. This tear forms a tube or canal within the wall of the aorta. Though the aorta goes down into the abdomen, this condition usually starts in the chest. In some cases, blood flowing within this canal can re-enter the aorta or perforate into the body and cause massive bleeding and even death. The most common symptoms of aortic dissection include:

 

A chest pain which is usually severe and may go through to the back. The pain may also move around as the condition spreads to involve more of the aorta         

 

Hope you liked this blog!

 

This blog is written by Dr. Bimal Chajjer (Best Heart Care Specialist)