Chest Pain

What is chest pain?

Chest pain refers to discomfort that occurs in any part of the chest and can extend to other upper body areas, including the neck, jaw, and arms. The pain may be dull or sharp, and it can also be accompanied by an aching or tightness, or a feeling of something squeezing or crushing your chest.

Chest pain usually lasts for a few minutes or hours but can, in some cases, persist for six months or more. It may worsen with exertion and improve with rest, though it can also occur while resting. The pain may be felt in one specific area or spread over a larger, more generalised region, and can occur on the left, middle, or right side of the chest.

It is important to seek medical help if you suspect your chest pain could be a heart attack or any other life-threatening condition.

Doctors often treat many patients with chest pain, making it a common symptom. However, it’s not always linked to the heart.

Symptoms

The sensation of chest pain can vary depending on its cause. In most cases, the trigger isn’t heart-related, though it’s difficult to determine this without consulting a healthcare professional.

Heart-related chest pain

Chest pain is frequently associated with heart problems. However, many individuals with heart disease report only mild discomfort, which they may not even recognise as pain. Discomfort caused by a heart attack or another heart condition may present the following symptoms:

• A feeling of pressure, tightness, burning, or fullness in the chest.
• Crushing or intense pain that radiates to the neck, jaw, back, shoulders, or one or both arms.
• Pain lasting more than a few minutes, worsening with activity, subsiding and returning, or varying in intensity.
• Shortness of breath.
• Cold sweats.
• Lightheadedness, dizziness, or weakness.
• Rapid heartbeats.
• Nausea or vomiting.

Other types of chest pain

It can be challenging to differentiate heart-related chest pain from pain caused by other factors. Generally, chest pain is unlikely to be heart-related if it occurs alongside:

• A sour taste or the feeling of food coming back into the mouth.
• Difficulty swallowing.
• Pain that improves or worsens with changes in body position.
• Pain that worsens with deep breathing or coughing.
• Tenderness when pressing on the chest.
• Pain that persists for several hours.

Heartburn, a burning sensation behind the breastbone, is a common symptom that may result from either heart or stomach problems.

Causes

There are several possible causes of chest pain, all of which require medical attention.

Heart-related causes

Common heart-related causes of chest pain include:

• Angina: Chest pain caused by reduced blood flow to the heart, usually due to plaque build-up in the arteries. It often occurs during physical activity when the heart requires more oxygen-rich blood.
• Heart attack: This occurs when blood flow to the heart muscle is blocked, usually by a blood clot. Angina may be a primary symptom of a heart attack.
• Aortic dissection: A life-threatening condition in which the aorta tears, allowing blood to flow between the layers of the artery wall.
• Pericarditis: Inflammation of the sac surrounding the heart, causing sharp pain that worsens with breathing or lying down.

Digestive causes

Chest pain can also result from digestive system issues, such as:

• Heartburn: A burning sensation caused by stomach acid rising into the oesophagus.
• Swallowing disorders: Conditions affecting the oesophagus can cause difficulty and pain when swallowing.
• Gallbladder or pancreas disorders: Gallstones or inflammation of the gallbladder or pancreas can cause pain radiating from the abdomen to the chest.

Muscle and bone causes

Certain types of chest pain are related to injuries or conditions affecting the chest wall, including:

• Costochondritis: Inflammation of the cartilage connecting the ribs to the breastbone.
• Sore muscles: Chronic pain conditions, such as fibromyalgia, can cause persistent pain in the chest muscles.
• Injured ribs: A fractured or injured rib can cause chest discomfort.

Lung-related causes

Several lung conditions can also result in chest pain, including:

• Pulmonary embolism: A blood clot in a lung artery, blocking blood flow to lung tissue.
• Pleurisy: Inflammation of the lining surrounding the lungs, causing pain that worsens with breathing or coughing.
• Collapsed lung: Sudden chest pain and shortness of breath due to air leaking between the lung and chest wall.
• Pulmonary hypertension: High blood pressure in the arteries that supply the lungs can cause chest pain.

Other causes

Other possible causes of chest pain include:

• Panic attack: Episodes of extreme fear, chest pain, and rapid heartbeat can mimic the symptoms of a heart attack. However, panic attacks may also involve excessive sweating, dizziness, nausea, and shortness of breath. Differentiating between a panic attack and a heart attack can be difficult, so it's important to seek medical advice if you're uncertain.
• Shingles: A viral infection causing severe pain and a rash, often extending from the back to the chest.

Diagnosis

Chest pain is not always a sign of a heart attack. However, emergency room doctors usually prioritise testing for heart problems, as they are the most life-threatening. Other critical lung issues, such as a blood clot or collapsed lung, may also be assessed.

Immediate diagnostic tests

Initial tests to diagnose the cause of chest pain may include:

• Electrocardiogram (ECG): A quick test to measure the heart's electrical activity, helping to detect abnormal heart rhythms or heart attacks.
• Blood tests: These check for proteins that leak into the blood after heart damage from a heart attack.
• Chest X-ray: This can show the state of the lungs, the size and shape of the heart, and detect lung problems like a collapsed lung or pneumonia.
• CT scan: This can identify blood clots in the lungs or an aortic dissection.

Follow-up tests

Depending on the initial test results, further testing may be required:

• Echocardiogram: Uses sound waves to produce moving images of the heart to detect abnormalities.
• Advanced CT scans: These can check for blockages in the heart's arteries.
• Stress tests: You may be asked to walk on a treadmill or ride a stationary bike while your heart activity is monitored.
• Coronary catheterisation: A flexible tube is inserted into a blood vessel to view blockages in the heart's arteries, often using dye to improve visibility in X-rays.

Treatment

The treatment for chest pain depends on the underlying cause and may include:

Medications

• Artery relaxers: Nitroglycerin tablets placed under the tongue relax the arteries, improving blood flow.
• Aspirin: Often given if chest pain is suspected to be heart-related.
• Clot-busting medicines: Administered to dissolve clots during a heart attack.
• Blood thinners: Prescribed to prevent clots from forming in the arteries.
• Acid-reducing medications: Used to reduce stomach acid if chest pain is caused by acid reflux.
• Antidepressants: May be prescribed to manage panic attacks, alongside cognitive behavioural therapy (CBT).

Surgery and other procedures

For more severe causes of chest pain, these treatments may be necessary:

• Angioplasty and stent placement: A procedure to open blocked arteries using a balloon and stent.
• Coronary artery bypass surgery: A new passage is created to bypass blocked heart arteries.
• Emergency repair surgery: Required for life-threatening conditions such as an aortic dissection.
• Lung reinflation: Performed to treat a collapsed lung.

Preparing for your appointment

If you experience severe, unexplained chest pain lasting more than a few minutes, contact your healthcare provider immediately. Don’t delay seeking assistance due to fear or embarrassment.

If possible, when seeking emergency treatment, provide the following information:

• Symptoms: Describe your symptoms in detail, including when they started and what worsens or alleviates them.
• Medical history: Share any previous chest pain experiences, as well as a family history of heart conditions or diabetes.
• Medications: Provide a list of the drugs and supplements you regularly take.

During your hospital appointment, your doctor will likely assess your condition quickly. Based on the results of your heart monitoring and blood tests, they will determine whether you are having a heart attack or if another condition is causing your symptoms.