Doctor’s Tip: Some causes of chest pain
Chest pain is a common concern of patients visiting primary care providers. Sometimes chest pain can be associated with serious — even life-threatening — conditions, other times not. Following are some common causes of chest pain:
Heart attacks occur when atherosclerotic plaque in walls of coronary arteries ruptures, resulting in a clot that completely blocks off the blood flow to part of the heart muscle. Typical symptoms include left chest pressure (“like an elephant sitting on my chest”), often with discomfort radiating to the left neck, shoulder and/or jaw. Associated symptoms include shortness of breath, sweating, nausea and light-headedness. About a third of heart attack patients — especially women, diabetics and the elderly — don’t experience chest pain, so lack of this symptom doesn’t rule out a heart attack. And sometimes the location of heart attack pain is atypical, such as the right chest or arm.
Angina is chest pain or tightness that occurs with exertion, often with radiation to the left neck, jaw, shoulder and/or arm. It is caused by insufficient blood supply to part of the heart muscle due to a partial blockage of a coronary artery, and it goes away with rest. Unstable angina is when chest pain that previously occurred only with exertion occurs at rest, in which case urgent medical attention is indicated.
Pneumonia is often associated with chest pain. Usually there are other symptoms, such as fever, chills and cough.
Pleurisy is a sharp pain with inspiration caused by an inflammation of part of the sac that surrounds the lungs. It is usually viral, although it can be a complication of bacterial pneumonia.
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Heartburn is a misnomer because it has nothing to do with the heart. When gastric acid refluxes up into the esophagus, where it doesn’t belong, the irritation causes a burning pain in the area of the sternum (breast bone). It is usually relieved by antacids.
Anxiety and depression can cause chest pain, usually in the breastbone area. The phrase “a broken heart” comes from chest discomfort that occurs with grieving, even though the source of the pain isn’t actually the heart.
Pulmonary embolus (blood clot to the lungs) is often associated with chest pain with deep inspiration. Often there are other symptoms, such as a rapid pulse and shortness of breath.
Costochondritis is an inflammation where a rib attaches to the cartilage on one side of the sternum (breast bone). The inflamed area is tender to firm touch and sometimes hurts with a deep breath. A similar condition can occur with the xyphoid process, which protrudes downward an inch or so below the sternum.
Chest wall strain: There are muscles in the chest wall, which can become strained just like any other muscles. A common cause is heavy repetitive lifting, such as starting a new upper body resistance program.
Herpes zoster (shingles) is caused by the chickenpox virus, which lies dormant but can break out later along a nerve root, causing a painful, red, raised rash. When the involved nerve root is in the chest area, the pain and rash occur in a band-like distribution on one side of the chest. When the pain precedes the rash by a few days, the diagnosis is difficult, but once the rash breaks out, it is obvious.
Fleeting chest pains: It’s not unusual for patients to complain of sharp, transient pains in various areas of their chest, lasting for a second or two. Studies have followed patients with this complaint for years, and there does not seem to be any correlation with any serious health problem.
The take-home message is: If you think you could be having a heart attack or unstable angina, call 911 immediately. If you have another potentially serious cause of chest pain, or if you aren’t sure, seek medical attention urgently.
Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email firstname.lastname@example.org.
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