Chest Pain
Introduction
Chest pain is a symptom that provokes considerable anxiety. Patients
are understandably concerned that their pains may be cardiac and lead
to a heart attack.
There are many causes for chest pain that are less serious, but of course
cardiac causes must first be excluded.
Typical cardiac chest pain is:
- located under the breastbone or at least some of the pain is situated
in this area.
- other features include provocation by exercise or stress
- relief by rest or nitroglycerin
If all three features are present the patient is said to have typical
angina. If two of the three features are present the patient is said to
have atypical angina and if only one of the three features are present
the patient is said to have non-anginal chest pain.
Angina pectoris is a symptom that occurs when blood supply to an area
of the heart muscle doesn't meet its needs. Angina may be felt as heaviness
below the breastbone which may spread to either arm, to the neck or the
back. On occasion, angina can be an indigestion-like discomfort in the
upper stomach or a burning or heartburn-like feeling below the breastbone.
Sometimes lack of blood supply to the heart may be experienced as shortness
of breath and in some patients the lack of blood supply to the heart may
be entirely silent.
Angina may occur during physical activity, at rest or it may awaken you
when you're asleep. Angina that becomes more frequent or severe, or that
occurs at rest and lasts for longer periods of time, is of greater concern.
This change in pattern of angina is known as UNSTABLE ANGINA and may be
an early warning sign of a heart attack. When angina lasts for longer
than 20 minutes, there is a risk that heart damage has occurred. If this
occurs, you should call your doctor or have someone take you to the nearest
hospital's Emergency Department.
Other causes of chest pain include:
- dyspepsia or heartburn
- esophageal reflux or spasm
- referred pain from other internal organs such as the gallbladder,
liver or spleen
- inflammation of the chest wall lining (pleurisy)
- inflammation of the sac around the heart ( pericarditis)
- inflammation of the chest wall muscles, cartilage or ribs
- referred pain from pinched nerves or other spinal pathology
- anxiety
In all cases a potentially serious cardiac cause should first be excluded
before a less serious diagnosis is made. For any persistent chest pain
the patient is cautioned to seek appropriate medical attention.
For instruction on how to use nitroglycerin see Cardiac
Medications - Nitroglycerin
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