In cardiovascular medicine, chest pain remains a common symptom that patients present with. In most cases, patients assume that having chest pain is due to a heart attack. However, this is not always the case. This article will briefly discuss the causes of chest pain in patients
1. Heart attacks – Chest pain is usually the presenting feature. Patients complain on central crushing pain that gets worse on exertion and may be relieved with rest. Pain radiates to the neck, jaw and down the left arm, and is associated with sweating and nausea. Occasionally, patients complain of palpitations and may feel light headed. Early investigation and treatment is required.
2. Angina – This is similar to chest pain that occurs with a heart attack, though it may be less severe. Patients who get angina that is brought on by exertion but is relieved promptly with rest or nitrate spray have what is called ‘stable’ angina. However, if the frequency of stable angina increases and patients find little or no relief with rest or nitrate spray, then it is called unstable angina. This warrants early investigation.
3. Musculoskeletal chest pain – This arises from the muscles between the ribs or from the ribs itself. Patients usually give a history of pulling a muscle or lifting something heavy. Pain is relieved with painkillers.
4. Pulmonary embolism – In this condition, breathlessness is the main symptom, though patients can present with chest pain. Pain is worse on breathing in and is sharp in nature.
5. Pleurisy – This refers to inflammation of the lining of the lung, also called the pleura. This is often associated with an underlying chest infection or pneumonia. Like pulmonary embolism, pain is worse on breathing in, and usually resolves with pain killers and treatment of the infection.
6. Acid Reflux – Here, patients complain of a burning sensation in the chest that is worse after meals and on lying down. It rarely radiates anywhere else, and can be promptly relieved with antacids.
These are the common causes of chest pain that are encountered in clinical practice. A good history is of utmost importance, and in most cases will provide a diagnosis even before any examination is conducted or any investigations are performed.