Overview
Chest pain is one of the most common reasons for emergency room visits. It has many different causes; it can originate from the heart, lungs, digestive system, muscles, or be psychological. The nature of the pain is decisive in determining the cause.
Not every chest pain is a heart attack; however, it should not be taken lightly because it may indicate a serious heart problem.
Symptoms and Types
Heart-related chest pain:
- Pressure, squeezing, or heaviness in the chest
- In the center or left side of the chest
- Radiating to the arm, shoulder, jaw, back
- Worsening with exertion
- Cold sweat, nausea may accompany
- Shortness of breath
Lung-related:
- Sharp, stabbing pain
- Changes with breathing
- Cough, fever may accompany
Digestive system:
- Burning pain
- Related to meals
- Bitter taste in the mouth
Musculoskeletal:
- At a specific point
- Increases with movement and touch
- Lasts hours to days
Psychological:
- During panic attack
- Palpitations, shortness of breath
- Fear of death
Emergency Situations
Call emergency services immediately:
- Crushing, squeezing chest pain (lasting more than 15 minutes)
- Pain radiating to the left arm, jaw, back
- Cold sweat, nausea accompanying it
- Shortness of breath
- Confusion
- Fainting
- Very fast or irregular pulse
Causes
Heart-related:
- Heart attack (myocardial infarction)
- Angina pectoris
- Aortic dissection (emergency)
- Pericarditis
- Myocarditis
- Cardiomyopathy
Lung-related:
- Pulmonary embolism (emergency)
- Pneumonia
- Pleurisy
- Pneumothorax (emergency)
- Asthma, COPD attack
Digestive:
- Reflux (GERD)
- Esophageal spasm
- Stomach ulcer
- Gallstones
- Pancreatitis
Musculoskeletal:
- Costochondritis
- Muscle strain
- Rib fracture
- Fibromyalgia
Other:
- Panic attack, anxiety
- Shingles (around the chest)
Risk Factors (For Heart-Related Pain)
- Age (men 45+, women 55+)
- Family history
- Smoking
- High blood pressure
- Diabetes
- High cholesterol
- Obesity
- Sedentary lifestyle
- Stress
When to See a Doctor
Emergency (call emergency services):
- Heart attack symptoms listed above
- Severe, sudden chest pain
- Fainting, confusion
Routine:
- Recurring chest pain
- Pain with exertion, relieved by rest
- If swallowing difficulty accompanies
- Frequent reflux symptoms
- If you suspect anxiety-related cause
Diagnosis
- ECG (first test to perform)
- Blood tests: Troponin, D-dimer
- Chest X-ray
- Echocardiography
- Stress test or stress echocardiography
- Coronary angiography (definitive diagnosis)
- CT angiography (for pulmonary embolism, aortic dissection)
- Endoscopy (digestive cause)
- Computed tomography
Treatment
Treatment is planned according to the cause:
- Heart attack: angio, stent, medications
- Angina: vasodilator, statin, antiplatelet
- Reflux: PPI, lifestyle change
- Muscle pain: pain reliever, rest
- Pulmonary embolism: anticoagulant
- Anxiety: psychotherapy, medication
Prevention
- Protect heart health
- Keep blood pressure, cholesterol, sugar under control
- Quit smoking
- Exercise regularly
- Maintain a healthy weight
- Follow a Mediterranean diet
- Avoid habits that cause reflux
- Manage stress
- Do not ignore symptoms