Chest pain is a very common symptom. It can understandably be very concerning for patients, and often causes significant worry. There are many different causes of chest pain, and they are not always related to the heart. It is important to distinguish between the different types of chest pain that are experienced, as it can affect the type of tests that may be required to understand the cause of the pain. Some of the more common causes of chest pain are described below.
Angina
Angina is a pain that comes from the heart. It is caused by a narrowing or blockage of the coronary arteries. The coronary arteries supply the heart muscle with oxygenated blood.
Angina results when the supply of oxygenated blood is not able to meet the demands of the heart muscle. This explains why most people that present with angina describe a pain in the chest that only occurs when they exert themselves, but they have no pain when sitting at rest. During exertion, the heart muscle needs a greater supply of oxygenated blood as it has to work harder. If there are narrowings or blockages, the flow down the arteries of the heart isn’t enough and this results in chest pain. Some patients also present with pain that occurs even when they are at rest.
The typical description of angina, is a pain in the chest which is more commonly on the left side or a band across the chest. It can also be felt on the right side of the chest more uncommonly. The pain is often described as a tight, dull, gripping or heavy pain. Some patients also describe it as a pressure on the chest. The pain can also move to other areas of the body, typically the arms, neck or jaw. Pain often comes on with exertion, and is relieved by rest.
Heart Attack
The pains that are described during a heart attack are often very similar to those described in angina, but go on for a longer period of time. The pain can come on with exertion or at rest. Often the pain is more intense and severe, and can be accompanied by other symptoms. Other symptoms that occur during a heart attack are sweating, feeling sick or vomiting, dizzy or light headed, and sometimes palpitations can also be felt.
This is a medical emergency, and if you have symptoms that sound like a heart attack you must phone an ambulance and go to Accident & Emergency. The longer the pain goes on, the longer the heart muscle is suffering from a lack of blood supply which results in damage to the heart. The quicker it is dealt with, the less damage there will be to the heart.
Indigestion or Acid Reflux
The symptoms of indigestion or acid reflux can be very similar to the pains that are experienced from angina or a heart attack. Indigestion, or ‘heart-burn’ is caused by inflammation of the lining of the oesophagus (gullet) caused by stomach acid. Patients often describe a pain at the lower chest or top of the abdomen, which can be quite severe. There is sometimes a relationship between the time that the pain occurs to eating, or certain types of food. Some patients also notice that the pain is bought on by stooping over, as the acid leaks back (reflux) from the stomach into the oesophagus.
Chest Infections and Pneumonia
Both chest infections and pneumonia can cause severe pain. The infection can sometimes cause inflammation of the lining that surrounds the lungs, which is called the pleura. Inflammation of the pleura is called pleuritis. The pain is usually worse when taking a breath in, and usually also associated with symptoms of a chest infection or pneumonia, which can include a cough, fevers, shortness of breath, and a cough that produces yellow, brown or green sputum.
Costochondritis
The rib cage is made up of the rib bones, which connect to the sternum with a softer and more flexible tissue called cartilage. The connection of the rib bone to the sternum with the piece of cartilage acts as a type of joint. This joint can become inflamed and cause pain. The pain is often described as a sharp or stabbing pain, and pressing in the area of the pain can make it worse. It can also be made worse by movement or deep breathing.
Muscular
The chest is made up of a large number of muscles. These muscles can sometimes be strained and lead to pains in the chest area. Although not always the case, muscular pains often follow an event that caused the pain, such as lifting some heavy boxes. Muscular pain can also be caused from trauma to the muscle, such as a blunt force to the chest. The pain is usually the result of stretching or tearing of some of the muscle fibres, which will repair themselves over time. Muscular chest pain is often made worse by movement, breathing in, or pressing the muscle that has been injured.
Pulmonary Embolus
A pulmonary embolus is a blood clot in the lungs. This can occur in completely fit and well patients, but is often associated with periods of immobility. Many people have heard of people suffering from a blood clot after a long-haul flight, which is caused by a period of immobility. This can result in a blood clot forming in one of the veins in the leg, which moves and lodges itself in the lung. There are other things that can increase the risk of having a pulmonary embolus. These can include smoking, cancer, recent surgery, pregnancy, obesity, and some oral contraceptive pills.
The symptoms that patients often report are chest pain that is sharp, and worse when the take a breath in. It can be associated with shortness of breath, and sometimes one of the leg calves is larger than the other and painful (if there is a blood clot in the leg).
Anxiety
This is an important cause of chest pain, but should always be a diagnosis that is made after ruling out any other causes. Pain can be very severe, and can very closely mimic angina pain. Da Costa’s syndrome is sometimes diagnosed as the cause of the chest pain, and is a psychiatric syndrome that can present with symptoms that are very similar to angina.