Chest pain is one of the leading causes of emergency room visits. Although it is the primary symptom of a heart problem, there are many possible causes for this complaint, some serious and others not considered serious.

Worldwide, chest pain affects 20%-40% of the general population.

Causes of chest pain:

First: Acute coronary syndromes

(Heart attack) includes myocardial infarction, superficial myocardial infarction, and unstable angina.

In these cases, chest pain is characterized by a heaviness in the center of the chest that increases with exertion and eases with rest. It lasts for more than a minute, unless there is a myocardial infarction, in which case the pain persists for more than 15 minutes and is accompanied by:

• Pain in the jaw, neck, or back
• Dizziness
• Pain in the shoulder or forearm
• Shortness of breath
• Women may experience sudden fainting, nausea, or vomiting.

If anyone suspects they are having a heart attack, they should seek emergency medical help. The sooner treatment is available, the better the chance of survival and the less damage to the heart.

Second: Pericarditis:

This is an inflammation of the sac surrounding the heart, causing severe chest pain that worsens when lying down and taking deep breaths and is partially relieved by bending forward.

Third: Myocarditis:

This is an inflammation of the heart muscle, leading to symptoms similar to a heart attack, such as:

• Chest pain
• Fever
• Shortness of breath
• Fast fatigue
• Rapid heartbeat

Fourth: Mitral valve prolapse:

When the mitral valve does not close completely during left ventricular contraction, this is a structural heart condition that may cause chest pain, palpitations, and dizziness. In some mild cases, it does not cause any symptoms.

Fifth: Aortic valve stenosis:

Aortic stenosis may be congenital, rheumatic, or age-related (calcified). Typically, the symptomatic pain of aortic stenosis is angina, caused by exertion and relieved by rest. In severe cases, it may be accompanied by fainting or progressive heart failure.

Sixth: Hypertrophic cardiomyopathy:

This is a hereditary condition that causes the heart muscle to thicken, preventing blood from flowing properly out of the heart. It is usually accompanied by shortness of breath, dizziness, fainting spells, or may lead to sudden cardiac death.

Seventh: Coronary artery dissection:

This is a rare condition that manifests as sudden chest pain, typically a severe tear in the neck, chest, or abdomen.

2. Causes in the aorta:

Aortic dissection is a separation of the inner layers of the aortic wall that causes blood to pass through the aortic wall, causing it to rupture. This is a life-threatening condition that requires immediate medical attention.

3. Pulmonary causes:

First, pulmonary embolism:

When a blood clot becomes lodged in the pulmonary artery that supplies blood to the lungs, it causes severe chest pain, difficulty breathing, coughing, and sudden fainting. If the pulmonary embolism is large, it can be life-threatening if not treated immediately.

Second: Pericarditis:

It is an inflammation of the membrane covering the lungs, causing severe chest pain when taking a deep breath.

Third: Pulmonary arterial hypertension:

Pulmonary arterial hypertension can sometimes lead to chest pain.

Fourth: Lung Collapse:

When air accumulates in the space between the lung and the rib cage, the lung collapses, causing sudden chest pain accompanied by shortness of breath and a rapid heartbeat.

Fifth: Pneumonia:

Pneumonia can cause severe stabbing pain associated with other symptoms such as fever, chills, cough, and phlegm.

Sixth: Bronchial Asthma:

Asthma is a common, recurring respiratory disorder characterized by recurrent inflammation of the airways, causing chest pain, shortness of breath, wheezing, and coughing.

4. Causes in the digestive system:

First, esophageal spasm, reflux, and esophagitis:

This is a muscle contraction in the tube that connects the mouth to the stomach. It presents as severe pain lasting from a few minutes to hours, worsening with swallowing food or liquids. It can cause a burning sensation in the chest and a sour taste in the mouth if acidic contents are refluxed into the esophagus.

Second: Esophageal rupture:

If the esophagus ruptures after severe vomiting, during vomiting suppression, or after esophageal surgery.

Third: Stomach ulcers:

These are ulcers in the stomach lining that cause severe pain, but they may also cause chest discomfort and may be confused with coronary artery syndromes.

Fourth: Hiatal hernia:

When part of the stomach protrudes into the chest, the pain is usually associated with eating and may be accompanied by symptoms such as heartburn and chest pain, especially with meals and when lying down.

Fifth: Pancreatitis:

This is a rare form of pancreatitis, characterized by pain in the upper abdomen and lower chest that worsens when lying down.

5. Causes in the chest:

First, muscle strain:

Inflammation of the muscles and tendons around the ribs can lead to persistent chest pain that worsens with activity or heavy lifting.

Second: Rib Injury:

Bruises and fractures of the ribs can cause severe pain, especially if there is a history of falls or injuries accompanied by a cracking sound.

Third: Costochondritis:

This is an inflammation of the rib cartilage. Costochondritis pain can worsen when sitting or lying in certain positions, as well as when engaging in physical activity.

6. Nervous causes:

First, cervical spondylosis and compressive neuropathy:

This is a compression of the spinal cord in the neck region that occurs with age over fifty. It is associated with a variety of symptoms, such as weakness and numbness in the hands, loss of balance, and pain in the arms that radiates to the chest due to pressure on the nerve.

Second: Shingles:

Herpes zoster is a viral infection that affects the skin on the chest. It begins as pain in the affected skin for several days, followed by a blistering rash.

7. Psychological reasons:

• Panic
• Anxiety
• Depression
• Hysteria

It is accompanied by other symptoms such as nausea, rapid breathing, excessive sweating, palpitations, feeling afraid, screaming and crying.

How to deal with chest pain?

It is always recommended to contact a doctor when dealing with chest pain, especially if the pain occurs suddenly and does not go away, if the patient is experiencing difficulty breathing, or if they experience life-threatening symptoms:

• Crushing pain in the sternum
• Chest pain radiating to the jaw, left arm, and back
• Change in level of consciousness, palpitations, or rapid heartbeat

Dealing with chest pain in the emergency department:

• Rapid Assessment: It is important to identify the patient’s life-threatening condition through…
• For acute coronary artery disease, the goal of the emergency room is to minimize myocardial damage through careful observation and rapid testing to determine the cause of the pain.
• Chest pain is assessed in the emergency room using a rapid assessment, a brief history, physical examination, and an electrocardiogram. Myocardial infarction can be diagnosed with an accuracy rate of 92% to 98%, and angina with an accuracy rate of 90%.
• Further assessment of undiagnosed chest pain is followed by a definitive diagnosis using cardiac enzymes.
• Chest x-rays can diagnose other acute conditions, such as aortic dissection, lung collapse, pneumonia, and rib fractures.
• Echocardiography is an important diagnostic tool for diagnosing hypertrophic cardiomyopathy, aortic stenosis, myocarditis, acute pulmonary embolism, pulmonary hypertension, and mitral valve prolapse. Stress ECG is an important tool for diagnosing angina pectoris in cases of a negative ECG and negative cardiac enzymes.

 

Dr. Bahjat Farag