Chest Pain: The Heart Of The Matter
The pain in my chest intensifies as I reach for a book on the shelf behind my desk. Inevitably, the fear of heart attack accompanies any chest pain. But I remember last night’s squash match and the lunge to make a point. The pain dulls as I drop my arm and returns when I lift it again. Making that shot apparently cost me a strained chest muscle.
Chest pain often has nothing to do with coronary disease. Most of my patients with chest pain have no cardiovascular problem at all. The cause of the chest pain is usually some minor, temporary problem—like my squash injury. In some cases, a serious chronic condition other than coronary disease is responsible for chest pain.
Where does it hurt?
Patients who come to me with chest pain often have minor musculoskeletal problems. Unlike cardiac pain, pain from a strained chest muscle intensifies and subsides as the strained muscle fibers contract and relax when you move. This pain can last for days.
An injury to your ribs or breastbone can cause severe chest pain. You can usually identify such contusions and fractures because they’re tender to the touch. Pain from a fractured rib can last for weeks. (Occasionally, arthritis affects one or more joints between the ribs and breastbone, causing chest pain.)
One of the most common sources of chest-pain complaints is heartburn, a burning sensation beneath your breastbone that worsens when you lie down. Typically, stomach acid flows up into the lower part of the esophagus, resulting in painful inflammation of the esophageal lining. That reflux may be caused by a hiatal hernia (when a part of the stomach protrudes through the diaphragm) or by overindulgence at the dinner table.
Some people have chest pain as a result of muscle spasms in the esophagus. Spasms typically occur during or shortly after meals, causing painful pressure in the center of the chest. Swallowing becomes difficult, and saliva accumulates in the mouth. Despite these distinguishing features, pain from esophageal spasms is often mistaken for a symptom of coronary disease. The masquerade is made more convincing because the pain may be relieved by drugs often prescribed for cardiac pain.
If the chest pain is sharp and increases with breathing, the problem is likely to be pleurisy, which is an inflammation of the lining of the lungs often caused by pneumonia or a pulmonary embolism (blood clot to the lung). That pain is sometimes accompanied by fever and shortness of breath, and prompt medical care is vital.
One disorder that’s especially difficult to distinguish from true coronary disease is pericarditis, an inflammation of the heart lining. This condition occurs most often in young adults and is usually caused by a viral infection accompanied by aches, chills, and fever.
Problems in other organs—some too far from the heart to seem likely suspects—occasionally lead to chest pain. Disorders of the gallbladder and pancreas can cause pain in the lower chest and upper abdomen. Gallbladder inflammation also causes pain near the right shoulder blade; pancreatic problems can bring on intense discomfort in the midback.
Chest pain—often with heart “palpitations” and sweating—may be caused by emotional problems, especially severe anxiety and panic disorders.
When pain comes from the heart
Despite the wide range of possible causes of chest pain, nearly everyone thinks first of heart attack and coronary disease. The classic symptom of coronary disease is angina pectoris. Angina indicates that the heart muscle isn’t getting enough oxygen because of decreased blood flow. Angina is typically a heavy, oppressive sensation in the center of the chest. The discomfort can radiate to the lower jaw, one or both arms (usually the left), and the upper back and neck. Angina generally strikes during physical exertion or emotional stress and can last as long as half an hour. More typically, the discomfort subsides within a few minutes when the exertion or stress ends.
Angina may be a precursor of a heart attack, which occurs when prolonged oxygen deprivation leads to the death of a portion of heart muscle. The pain of a heart attack resembles angina but typically lasts longer and is a more severe, crushing sensation. A heart attack is often accompanied by clammy skin, sweating, nausea, shortness of breath, and weakness.
If you’ve never had chest pain before and it strikes during physical exertion, call your physician immediately. If symptoms don’t subside with rest, take an aspirin, preferably by chewing it—and followed by water, and call 911 to transport you quickly to the nearest hospital emergency room. When a heart attack is coming on, every minute counts. Immediate treatment in the ambulance and at the hospital can be life-saving.
Finding the cause
Because chest pain doesn’t always come from the heart, it’s crucial for physician and patient together to sort out the characteristics of the pain. What does the pain feel like? When does it occur? What makes it better? What makes it worse? What you tell your physician helps determine the diagnostic or therapeutic route to follow and may spare you needless and possibly harmful tests.
Health handbook introducing you to read the article: Cardiovascular Disorders
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