Chest pain

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Chest pain is a common symptom that can be caused by many different conditions.

The cause can be difficult to determine.

Chest pain can have a serious cause, such as heart attack, angina or tearing of the aorta.

 You should not ignore chest pain. Self-diagnosis may be inappropriate; you won’t know whether the cause is serious until a medically trained person has evaluated you.

 Other causes of chest pain may be unrelated to the heart and can be evaluated as non-emergencies, such as gastroesophageal reflux disease, gallstones, or inflammation of the chest wall.

  Even if your chest pain has nothing to do with your cardiovascular system, the problem may still be important.

Cause

Chest pain can be due to a heart attack or angina or could be caused by other factors:

Heart attack

Important: Chest pain can be an important warning symptom of a heart attack. The symptoms of a heart attack include:

 Chest pain that is crushing, squeezing, or feels like a heavy weight on the chest, a tight band around the chest or a dull ache in the middle of the chest resembling indigestion

  Chest pain associated with shortness of breath, nausea or vomiting, pain radiating from the chest to the neck, jaw, or one or both arms, dizziness or light-headedness, increased perspiration, fast or irregular pulse.

If you have symptoms of a heart attack, call your nearest emergency service immediately.

Angina

If chest pain is caused by angina it also requires urgent medical attention. The symptoms of angina include pain that:

Feels like squeezing, pressure, heaviness, tightening, or aching across the chest, usually in the middle of the chest

  Often radiates to the neck, jaw, arms, back, or even the teeth

    

 Might feel like indigestion or heartburn

  Is associated with weakness, sweating, nausea and shortness of breath

Is precipitated by exercise.

Other

Many conditions may cause chest pain similar to that of a heart attack or angina, including:

 Pleuritis/pleurisy – inflammation of the lining of the lung

   Pulmonary embolism – a blood clot lodged in one of the arteries in the lung

  Pneumothorax – air leakage from the lung into the chest cavity

   Pericarditis – inflammation of the sac lining the heart

   Mitral valve prolapse – a relatively benign valve abnormality in the heart

   Aortic dissection – a tear running in the wall of the aorta

  Costochondritis – inflammation of the cartilage in the small joints between ribs and the breastbone

   Rib fractures – usually related to trauma

  Nerve compression – pressure on the nerves running in the chest

 Shingles – nerve infection by the herpes zoster virus

Oesophageal spasm and reflux – spasm of the oesophagus and regurgitation of the stomach acid into the oesophagus

 Gallbladder problems, such as a gallstone attack

  Anxiety and panic attack – often associated with hyperventilation

Diagnosis

Here are some things to think about when you or someone you know has chest pain that is not caused by angina or heart attack. This information should be relayed to the medically trained person you consult.

Have you had an injury?

  Pain may be caused by an injury to muscles, tendons or ribs

  Pain related to an injury occurs with movement of a shoulder, an arm, the rib cage, or the trunk of the body

   Deep breathing, coughing or sneezing may also increase the pain

  Pain that starts immediately after a severe injury may mean there has been damage to organs inside the chest, such as the lungs, heart or blood vessels. Or other symptoms, such as true shortness of breath or shock, develop quickly.

This type of injury requires urgent medical attention

What makes the pain better or worse?

 Pain that gets worse when you press on the area may be caused by chest wall pblems, such as inflammation of cartilage in the chest wall (costochondritis)

 Pain that gets worse with deep breaths, coughing or sneezing may be caused by inflammation of the lining of the lung (pleurisy), or free air in the chest cavity (pneumothorax).

Pain that is made better or worse by eating may be caused by a problem in the abdomen, such as an ulcer, gallbladder disease, reflux disease or inflammation of the stomach.

What does the chest pain feel like?

 A sharp pain that lasts only a few seconds may be caused by a minor problem such as chest wall pathology.

  Sudden, severe chest pain with a fever may be caused by inflammation of the membrane (pericardium) that surrounds and protects the heart (pericarditis).

   Burning or gnawing pain at the top of the abdomen may be caused by an ulcer, gallbladder disease, heartburn or inflammation of the stomach (gastritis).

   In very rare cases, severe chest pain may be caused by an aortic aneurism bulging out of the main vessel (aorta) that carries blood from the heart to the body. Pain may indicate that the aneurism is getting bigger or has torn into the wall of the aorta.

Does the pain seem to spread to other areas of the body?

 Pain that starts in the upper belly and spreads up into the chest may be caused by heartburn

  Pain that spreads around only one side of the chest may be caused by an inflammation such as shingles. Shingles may cause a rash of chickenpox-like blisters around one side of the chest.

 Pain that spreads from the upper belly to the chest and back may be caused by gallbladder disease or disease of the pancreas.

Do you have chest pain with any other symptoms?

  Chest pain and a fever, runny nose or cough may mean a respiratory infection

 Chest pain and true shortness of breath may mean there is a blood clot in the arteries of the lung (pulmonary embolus).

Treatment

Home

Minor chest pain

Specific home treatment for chest pain depends on the cause of the pain. Often minor chest pain improves with home treatment and does not require a visit to a health professional.

Chest wall pain caused by strained muscles or ligaments or a fractured rib

Use pain relievers (analgesics), such as nonsteroidal anti-inflammatory drugs (including Brufen), or Panado. Ointments containing anti-inflammatories, such as Voltaren Gel, may also help. Do not give aspirin to anyone under the age of 20.

Use an ice pack to help relieve pain the first few days after an injury.

Use heat (a hot-water bottle, warm towel or heating pad) after 48 to 72 hours of cold treatments (or when the swelling is down) to help relieve the pain. Experts do not agree on the use of heat after an injury. Some think it increases swelling and bruising; others believe it may speed healing. If you use heat, be careful not to burn your skin. Use heat that is no warmer than bath water or the low setting on a heating pad. Remember, do not go to sleep with a heating pad.

As your pain lessens, slowly return to your normal activities. Any increased pain may be a sign you need to rest a while longer.

Hyperventilation

For home treatment of hyperventilation caused by anxiety or panic attacks:

Focus on slowing your breathing.

   Breath in and out of a paper bag held over the nose and mouth. Keep this treatment up for two to three minutes. Remove the bag for five minutes, and repeat breathing into the bag for two to three minutes. Keep this cycle up until breathing has returned to normal. This will help bring the amount of CO2 in the blood back to normal. To prevent the level of oxygen (O2) in the blood from dropping too low, it is important to take breaks from breathing into the bag.

Symptoms to watch for during home treatment

Consult with your doctor if:

 Your chest pain is not relieved by home treatment

The pain lasts longer than four weeks

   Your symptoms become more severe or frequent