What is Chest Pain?
Chest Pain is the pain in the chest region and, more commonly, on the front side. The pain may vary in intensity and may or may not be associated with other symptoms. A number of medical conditions, including, more commonly, those related to the heart and the lungs, can present as Chest Pain.
Is chest pain condition a medical emergency?
Chest Pain can indicate a medical emergency and requires prompt evaluation.
Types
Chest pain may be mainly classified as:
- Cardiac or heart related
- Non-cardiac or non-heart related
Causes
A number of medical conditions can result in chest pain and may include the following:
- Cardiac
- Acute coronary syndrome
- Stable and Unstable Angina
- Myocardial infarction
- Aortic dissection
- Aortic Aneurysm
- Prinzmetal Angina due to coronary vasospasm
- Hypertrophic Cardiomyopathy
- Pericarditis
- Myocarditis
- Cardiac Tamponade
- Mitral Valve Prolapse
- Aortic Stenosis
- Arrhythmias
- Respiratory
- Pulmonary embolism
- Bronchitis
- Pleurisy
- Pneumonia
- Asthma
- Lung cancer
- Pneumothorax
- Hemothorax
- Gastrointestinal
- GERD
- Esophageal spasm
- Esophagitis
- Esophagial rupture
- Acute Gastritis
- Acute Pancreatitis
- Acute Cholecystitis
- Perforated Peptic Ulcer
- Chest wall and other related conditions
- Costochondritis
- Precordial Catch
- Tuberculosis
- Rib Fracture
- Osteoarthritis
- Herpes zoster affecting the chest region
- Thoracic Outlet syndrome
- Prolapsed Intervertebral Disc
- Hiatus Hernia
- Psychological
- Anxiety
- Panic Attack
- Hypochondria
- Others
- Carbon monoxide poisoning
- Lead poisoning
- Sarcoidosis
- Hyperventilation syndrome
Symptoms & signs
Chest pain may vary in intensity and duration and may or may not be associated with other symptoms. Some common types of Chest Pain include:
- Pressure like sensation
- Stabbing pain
- Burning pain
- Fullness or tightness
- Sharp pain or persistent dull pain
- The pain may radiate to the jaws, neck, back, shoulders, arms, and upper abdomen
Symptoms that may be seen along with chest pain include:
- Shortness of breath
- Cold sweats
- Dizziness
- Nausea and/or vomiting
- Difficulty swallowing
- Sour taste in the mouth
- Pain on touch
- Increase or decrease in pain when changing body position
Investigations
Some investigations that are advised for the evaluation include:
- Laboratory tests
- CBP & ESR
- Liver and renal function tests
- Complete metabolic panel
- Cardiac markers: Troponin i or t
- Creatine kinase
- D-dimer (To rule out pulmonary embolism)
- Serum Lipase: (To rule out acute pancreatitis)
- Imaging tests
- Chest – X-Ray
- CT Scan
- Echocardiography: If there is a known history of cardiac disease
- CT pulmonary angiogram: If pulmonary embolism is suspected
- ECG: It is usually the first test that is advised
- Coronary catheterization
Diagnosis
A diagnosis of the underlying cause responsible for pain is established based on medical history, clinical evaluation, and results of the investigations done.
Treatment options
The treatment depends on identifying the underlying medical condition and treating it. Treatment of chest pain may include medical and surgical interventions based on the underlying cause and the general health of the individual.
Medical management
Medical management of chest pain may include:
- Analgesics: For the management of pain
- Thrombolytics: to help dissolve the clot and restore the blood flow. It is advisable to administer via injection within 30 minutes of the onset of symptoms
- Nitroglycerin: To improve the blood flow through the arteries
- Antiplatelet drugs: To prevent the formation of clots within the arteries
- Angiotensin-converting enzyme (ACE) inhibitors: To increase the blood flow and decrease blood pressure, thereby decreasing the workload of the heart
- Angiotensin receptor blockers: To reduce the blood pressure and the workload of the heart
- Beta-blockers: To reduce heart rate and the workload of the heart
- Statins: To reduce the amount of cholesterol in the blood to stabilize existing plaques and prevent them from rupturing
- Antacids: For reducing the production of acid if certain gastrointestinal causes are responsible for causing Chest Pain
- Antidepressants: For the management of panic attacks or anxiety
Interventional including surgery and indications for surgery
Interventions for managing Chest Pain depend on the underlying cause, its severity, and the individual's general health.
For cardiac causes of Chest Pain, the following may be done:
- Angioplasty and stenting: This is a minimally invasive interventional cardiology procedure, such as percutaneous coronary interventions, in which a balloon is guided through a catheter to unblock or widen the arteries. In addition, a tiny tubular metal mesh called a stent is placed inside the artery to support and keep the artery open. It is advisable to perform this procedure within 90 minutes from the onset of symptoms.
- Coronary bypass surgery or coronary artery bypass grafting (CABG): It is a procedure where the blockage is significant, and an arterial graft is used to bypass the blocked artery and restore the blood supply to the heart.
- Dissection repair: If aortic dissection is present
Other procedures for managing non-cardiac causes may include procedures for managing lung or gastrointestinal conditions that can cause Chest Pain.
Role of Diet/ Exercise/ Lifestyle changes/ Preventive measures
Some of the measures that can be taken include:
- Quitting smoking
- Eating a healthy diet that includes fruits, vegetables, lean meats, and low-fat dairy
- Getting regular exercise and staying physically fit
- Maintaining proper body weight
- Monitoring and keeping blood cholesterol levels under control
- Monitoring and controlling blood pressure levels
- Reducing mental and emotional stress
- Keeping a check on alcohol consumption
- Cognitive-behavioral therapy: If psychological causes are identified
- Physical therapy: If mechanical causes are identified
Prognosis
The prognosis depends on the underlying cause, as well as the general health condition of the individual. It is due to cardiac causes in about 20-25% of the cases, while other medical conditions contribute to the remaining cases.
When to contact the doctor or hospital? / How to identify the emergency or complications?
It is advisable to seek immediate medical attention if there is Chest Pain, especially with other symptoms such as dizziness, sweating, etc.
Indications for hospitalization if required
Depending on the underlying cause of Chest Pain, hospitalization may be required for its management in certain conditions.
Suggested clinical specialist/ Departments to consult for this condition
- Emergency medicine
- Cardiology
- General medicine
- Gastroenterology
- Pulmonology