Chest pain can have different causes.

Having chest discomfort does not necessarily mean you are having a “heart attack”. However, chest pain can possibly be a sign of a heart attack. Hence, it is important to seek immediate help.

Chest pain generally originates from one of the organs in the chest (heart, lung, aorta or oesophagus) or from the components of the chest wall (skin, muscle, nerve or bone). Occasionally, organs near the chest, such as the gallbladder or stomach, can cause a “referred” chest pain.

Chest pain characteristics are important and, depending on the cause, chest pain can be:

1, Dull, sharp, pressure-like, burning, tightness or squeezing

2, Located in one or several spots: left chest, middle of the chest, neck area

3, It can radiate to the arms, jaw, neck, or back,

4, It can worsen with activity and improve with rest, change with body position (flat versus sitting), and can be or not be reproduced by manual pressure on the chest wall

5, It can be isolated or associated with shortness of breath, dizziness, sweating, nausea, irregular or rapid heart rate

6, It can have a different duration – ranging from a few minutes to hours

7, It can have a different response to treatment: as an example, nitroglycerin can relieve angina as explained below, whereas antacids can relieve gastric reflux disease.

What are the causes of chest pain?

Angina

The coronary arteries run on top of the heart muscle and supply it with oxygen and nutrients. In people with coronary heart disease, such vessels become blocked with fatty deposits called atherosclerosis plaques, which cause the coronary arteries to narrow or close and prevent adequate heart muscle perfusion. This is called coronary ischemia. "Angina" is the term for chest pain caused by this mechanism.

Angina is particularly reported during physical activity because the high demand for oxygen exceeds the supply delivered to the heart muscle, by the blocked coronary arteries.

Angina is not affected by taking a deep breath or by pressing on the area of discomfort. It is usually relieved within a minute or two of taking nitroglycerin, a medicine that dilates the coronary vessels and is administered as a spray or a tablet under the tongue.

Heart attack

Also called myocardial infarction, a heart attack occurs when one of the above described cholesterol plaques suddenly ruptures and builds a clot on top of it, partially or completely blocking the artery in question, and leading to heart muscle damage. A heart attack may feel similar to angina but is usually more prolonged and more intense. It can happen at rest or with effort.

Coronary spasm

Some people without significant coronary artery disease may develop the classic pain of angina. This is called "variant angina" and may be caused by a temporary spasm of the coronary arteries. In such instance, the arteries are usually normal or have minor disease only, but it is the spasm that causes limited blood flow and consequent cardiac muscle suffering.

Pericarditis

This is inflammation of the membranes around the heart. It can cause chest pain that gets worse when you take a deep breath, cough, or sneeze. The pain may also worsen when lying back and may be relieved with leaning forward. It is usually related to a viral illness or certain systemic diseases or medications.

Myocarditis

This is inflammation of the heart muscle itself. It can cause chest pain that may mimic angina. Myocarditis is often caused by a viral infection and, depending on its extent, can be self-resolving or may lead to major cardiac complications.

Other heart conditions

Conditions such as hypertrophic cardiomyopathy, mitral valve prolapse, and aortic stenosis can all cause chest pain.

Aortic dissection

This is much less common than the above conditions. The aorta is the main artery in the body; it comes out of the heart and carries blood to the different organs. In an aortic dissection, the inner lining of the aorta ruptures or tears, causing a significant compromise to the blood circulation.

It is a very serious condition that often requires emergency surgery or can lead to death in a short period of time. The pain is usually sudden and excruciating and feels like a tearing sensation. It is often felt in the chest, back, and between the shoulder blades.

Pulmonary embolism

A lung clot can cause chest pain, acute shortness of breath, rapid heartbeat, and a sensation of “doom”. If undiagnosed and untreated, it can be another life-threatening condition. Lung conditions like pneumonia or pleurisy (inflammation of the lung lining), can also generate chest pain.

Gastrointestinal causes

Problems with the oesophagus and the stomach can mimic cardiac pain and a distinction may not be possible without further tests.

Costochondritis

This is when the cartilage that connects the ribs to the breastbone becomes inflamed, causing pain. Again, it is usually from a viral infection and is self-limited.

Other medical conditions

Conditions such as rheumatoid arthritis, fibromyalgia, shingles and trauma can affect the different components of the chest wall and cause chest discomfort.

Psychological causes

Panic attacks or a mood disorder may cause a person to feel pain in the chest.

In next Tuesday’s article, the diagnosis and treatment of chest pain will be discussed.

• Joe Yammine, MD is a consultant cardiologist at the Bermuda Hospitals Board. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician