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Chest pain

 

Chest pain is one of the most frightening symptoms you can have. It is also difficult at times to assess the source of chest pain and whether it is life threatening. Each of these parts of the chest can cause chest pain: the heart, the lungs, the esophagus, muscle, bone, and skin. Also, because of the complex nerve distribution in the body, the cause of chest pain may come from sources not located in the chest. The stomach or other organs in the abdomen, for example, can cause chest pain.

    • Chest pain originating from the esophagus: Esophageal disorders can cause chest pain, which is an alarming symptom because it often mimics chest pain from a heart attack.

       

      • Gastroesophageal reflux disease (GERD) occurs when acidic digestive juices backflow from the stomach into the esophagus.

         

      • Esophagitis is an infection of the esophagus.

         

      • Esophageal spasm is defined as excessive, intensified, or uncoordinated contractions of the smooth muscle of the esophagus

Causes

S&S
 

  • Typical heart attack pain occurs in the mid to left side of the chest and may also extend to the left shoulder, the left arm, the jaw, the stomach, or the back. Other associated symptoms are shortness of breath, increased sweating, nausea, and vomiting.

  • Angina is classified as chest pain that is similar to that of a heart attack but occurs with increased exercise and is relieved by nitroglycerin taken under the tongue. Angina becomes life-threatening when pain occurs at rest, has increased in frequency or intensity, or is not relieved with at least 3 nitroglycerin tablets each given 5 minutes apart. This is considered to be unstable angina, which may be a warning sign of an impending heart attack.

  • The chest pain associated with aortic dissection occurs suddenly and is described as "ripping." The pain may radiate to the back or between the shoulder blades. Because the aorta supplies blood to the entire body, people may experience symptoms such as chest pain, shortness of breath, fainting, abdominal pain, or symptoms of stroke.

  • Symptoms of a pulmonary embolus are sudden onset of shortness of breath, rapid breathing, and sharp mid-chest pain, which increases with deep breaths.

  • Signs and symptoms of pneumothorax are sudden onset of shortness of breath, sharp chest pain, rapid heart rate, and low blood pressure.

  • Perforated viscus comes on suddenly with severe abdominal, chest, or back pain or pain in both places. Abdominal pain may increase with movement or when breathing in and may be accompanied by a rigid, boardlike abdominal wall.

  • The pain of pericarditis is typically described as a sharp or stabbing pain in the mid-chest area, worsened by deep breaths. This pain may mimic the pain of a heart attack, because it may radiate to the left side of the back or shoulder. One distinguishing factor is that the pain is worsened by lying flat and improved by leaning forward. When lying flat, the inflamed pericardium is in direct contact with the heart and causes pain. However, when leaning forward, there is a space between the pericardium and the heart. Prior to the onset of the chest pain, people may note having a recent cold, fever, shortness of breath, or pain when swallowing.

  • Although mitral valve prolapse is not usually associated with symptoms, people may experience palpitations (feeling the heart beat) and chest pain. Chest pain associated with MVP differs from that of typical angina in that it is sharp, does not radiate, and is not related to physical exertion. Other associated symptoms include fatigue, lightheadedness, and shortness of breath. Anxiety also seems to be more common in people with MVP than in the general population. Complications of MVP include infection of the heart valves, migraine headaches, stroke or mini-stroke, and abnormal heart rhythms, which rarely cause sudden death.

  • Pneumonia may cause chest pain from the strain of the chest wall muscles during prolonged or forceful coughing.

  • With chest pain originating from the esophagus, symptoms depend on the source.

     

    • Symptoms of gastroesophageal reflux disease (GERD) include heartburn, painful swallowing, excessive salivation, dull chest discomfort, chest pressure, or severe squeezing pain across the mid chest. People may appear comfortable or may experience profuse sweating, pallor, nausea, and vomiting. Pain from GERD is often relieved with antacids.

       

    • Symptoms of esophagitis include difficulty swallowing, painful swallowing, or symptoms of GERD. The associated chest pain comes on suddenly and is not relieved by antacids.

       

    • The pain of esophageal spasm is usually intermittent and dull. It is located in the mid chest and may radiate to the back, neck, or shoulders.

If you suspect that you may be having a heart attack, call 911 for emergency services or go to the nearest hospital Emergency Department.

  • If you think you are having a heart attack, it is advisable to chew at least 2 baby aspirin or 1/2 of a regular aspirin—that's a total of 160 mg. It is important to chew the aspirin as opposed to swallowing it because chewing decreases the time the medicine is delivered to the body. Aspirin chewed in the early stages of a heart attack may reduce the possibility of death by 23%.

  • If you have nitroglycerin tablets available, place one under your tongue. This may aid in increasing blood flow to blocked or narrowed arteries.

     

    • If you have been previously diagnosed with angina and your doctor has prescribed nitroglycerin (sublingual, which means you place the tablets under your tongue), try placing one tablet under your tongue.

       

    • If your chest pain continues in the next 5 minutes, you should take another tablet under the tongue.

       

    • If after 3 sublingual nitroglycerin tablets, you do not have relief of the chest pain, you should immediately call 911 or go to the nearest Emergency Department.

  • Pain from GERD is often relieved with antacids. Even if your pain goes away, you may not safely assume you are not having a heart attack. Esophagitis and esophageal spasm are typically not relieved with antacids.

When to ask for help

If you suspect that you may be having a heart attack or any symptom of chest pain, call 911 or go to the nearest hospital's Emergency Department. Do not attempt to drive yourself.

 

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Constructed by Dr N.A. Nematallah Consultant in perioperative medicine and intensive therapy, Al Razi Orthopedic Hospital , State of Kuwait, email : razianesth@freeservers.com