Types of chest pain, and how to know when to seek help

Chest pain is the sensation of pain or discomfort in the chest that can be sharp and pointed, or dull and aching. It may start and remain in the chest, but it could spread to other areas of the torso and into the neck or jaw. There are many conditions and situations that may trigger chest pains, and not all of them are serious. In this article, seasoned consultant cardiologist Dr Marco Spartera tells how to differentiate between the types of chest pain.

What causes chest pain?

In most cases, chest pain may not have anything to do with the heart, but instead be triggered by issues with the digestive system, the lungs, muscles in the chest, and even psychological states.

Examples of chest pain caused by digestive problems:

• Heartburn is a burning feeling behind the breastbone that occurs when stomach acid flows up through the oesophagus. This is called acid reflux.
• Gallbladder or pancreas problems, such as gallstones or inflammation, can cause pain in the upper right area of the abdomen that spreads to the chest.

Examples of chst pain caused by pulmonary problems:

• Pulmonary embolism, where a blood clot has gotten stuck in the arteries of the lungs, obstructing blood flow to those tissues and causing pain.
• Collapsed lung, where air gets into the space between the lungs and the chest wall, causing shortness of breath and tightness of the chest.
• Pneumonia or chest infections, where the lungs may become inflamed and causes stabbing pain whilst breathing deeply or coughing.

Examples of chest pain caused by tissue, muscle, and bone problems:

• Costochondritis, where the cartilage of the upper rib cage becomes inflamed and painful.
• Fibromyalgia, which is a chronic disease that is characterised by pain in the muscles, tendons, and other soft tissues.
• Injured ribs, such as a fracture or bruise, will cause pain in the chest

Chest pain can be further caused by a panic attack, where the heart may begin palpitating intensely, and shingles, a viral rash where heart pain is one of the earliest symptoms.

When does the heart cause chest pain?

In cases where chest pain is actually related to the heart and its condition, it is likely due to a restriction of blood flow to the heart. This is called angina, and the pain will feel tight, dull, and heavy, spreading to down the arms and up the neck. It will be triggered by physical exertion and will subside when resting. It could be accompanied by nausea and shortness of breath, but normally doesn’t last too long.

The reason why blood flow to the heart can become obstructed is due to the build-up of plaque in the arteries, reducing the heart’s blood supply. To make up for the reduced blood flow, the heart will work harder, which strains and weakens the heart.

Heart attacks feel much like angina pain, but more prolonged and dire. They are caused by a blood clot or other blockages in an artery in the heart, necessitating immediate medical intervention to unclog the artery.

Pericarditis is when the membrane around the heart becomes inflamed, and causes sharp pain that is worse when lying down or breathing in, as well as a dull ache all over the chest. It can be caused by infection, autoimmune diseases, and corticosteroids.

Chest pain from the heart is more likely for people who are older or who are at risk for heart disease. This includes people who smoke, who have obesity, high blood pressure, diabetes, or high cholesterol, or who have a family history of heart attacks and angina.

How is chest pain diagnosed and treated?

To determine the cause of chest pain, a doctor will likely order an electrocardiogram, a quick test to measure the electrical activity of the heart. Other tests that may be conducted for the diagnostic process could be:

• MRI scans
• X-rays
• CT scans
• Ultrasound scans
• Blood tests

Once a diagnosis has been made, a treatment plan can be formulated, as different conditions will have different requirements. Aside from lifestyle adaptions for heart health, such as ceasing tobacco consumption, eating less food with saturated fats, and partaking in more physical activity, medications and surgical procedures can be utilised to manage chest pain.

Medications used in the treatment of chest pain include:

• Nitroglycerin and other artery relaxers to facilitate easier blood flow
• Aspirin, a type of nonsteroidal anti-inflammatory drug used to treat pain, and inflammation, and thins the blood.
• Thrombolytics, which are administered to those with blood clots and heart attacks to dissolve clots.
• Acid-reducing medicines, to neutralise the stomach acid in cases of heartburn.
• Anti-anxiety medication, for those experiencing panic attacks. Psychotherapy, such as cognitive behavioural therapy, also might be recommended.

A surgical procedure, called angioplasty, treats angina by widening the blood vessels, but not all patients with angina are suitable to undergo this surgery.

Even though most cases of chest pain may not be grave, it is better to be safe than sorry. The chest pain may be quick to come and quick to go, but that does not mean that the cause isn’t serious. Do not ignore the pain and always consult with a medical professional when experiencing chest pain.

If you are experiencing chest pain and would like to consult with Dr Spartera, you can do so via his Top Doctors profile.