CHEST PAIN: Medical Emergency or Bad Burrito?
There’s a medical term for everything, sometimes to make the dreadful
sound common place and sometimes to make the simple sound deeply
complex; thus does a stroke become an “accident” and sneezing becomes “sternutation.” The
medical term for chest pain is—wait for it—“chest pain,” and not “angina,” as
many believe (as we will see below, angina actually refers to a
very specific subset of chest pain). Chest pain is almost certainly
the single most feared individual symptom that affects human beings,
in large measure because its cause can be as innocuous as a bad
burrito or literally as serious as a heart attack. Understanding
the different types of chest pain, and their possible causes, can
be the key to distinguishing between these extremes, and to alleviating
unnecessary anxiety while seeking medical care when required.
Almost everyone will experience unexplained chest pain at one point
or another, and many will immediately assume that they are having
a heart attack, or some other problem directly related to the heart.
However, this is not always or even usually the cause of acute chest
pain. Roughly 20%-30% of patients who present to the emergency room
with chest pain have a problem with the esophagus or stomach; chest
pain may also result from panic disorder, which will affect an estimated
three million Americans at some point in their lives.
Consequently, the first important step if you experience acute
chest pain is to avoid panic. Take a moment to assess the pain you
are experiencing. If pain lasts less than 30 seconds, or disappears
when you take a deep breath or change position, it’s probably minor
in nature. If the pain endures, note whether you are experiencing
any other symptoms that may help you or your health care provider
shed light on the origin of that pain. Finally, report to the emergency
room or to your physician’s office if you feel it necessary.
WHAT TO DO
If you begin experiencing a bout of acute chest pain, and you’ve
ruled out injury or Atomic Buffalo Wings as potential causes, your
next course of action will depend both upon the nature of the pain
and the symptoms that surround it. The first consideration is to
determine whether the pain signals an oncoming heart attack; if
pain is crushing, extremely severe, originates in the left arm,
or is accompanied by nausea, sweating, and shortness of breath,
you should head for the emergency room and ask questions later.
Next up, look for symptoms that might suggest a cold— cough, chills,
runny nose, fever—and try to characterize the pain (is it sharp
or dull? Does it feel like pressure? Is it central or located to
one side? The answers to each of these questions can be instrumental
in identifying an origin for the pain). Are there other symptoms
that seem significant? Is there, for example, numbness around your
lips and hands? This may be a sign that your chest pain is caused
by hyperventilation.
If you have access to a computer you can also evaluate your symptoms
using a variety of online symptom checkers from various sources
on the medical Internet. These often take the form of good, old-fashioned
flowcharts—answer “yes” or “no” questions about your symptoms to
proceed through a series of boxes, and figure out what might be
wrong with you. One example of such a flowchart, specific to chest
pain and offered by familydoctor.org, can be found at http://familydoctor.org/flowcharts/523.html.
Most importantly, no information gleaned from the Internet, print
publications, or other sources can ever replace a consultation with
a physician. If you are experiencing chest pain of unknown origin,
and it concerns you, make an appointment to speak with your doctor.
FMNG
POSSIBLE CAUSES
There are dozens of possible causes of chest pain. Relatively benign
causes can include muscle strain subsequent to exercise, severe
indigestion, the aforementioned panic attack, and injury to the
chest. Below, you’ll find brief descriptions for a number of conditions
that may lead to chest pain, along with links to additional information.
BRONCHITIS/PNEUMONIA
Chest pain may result from severe coughing associated with viral bronchitis,
pneumonia, or similar conditions. Bronchitis is one of the most common diagnoses
in modern medicine; if you have been diagnosed with the disease, and your
chest pain seems to be tied to cough, then your infection may be the cause
of said pain.
GERD
Gastroesophageal reflux disease, or GERD, affects at least an estimated 5%
to 7% of the global population. Its most common symptom is chronic heartburn;
when acid from the stomach flows into the esophagus, chest pain may be the
result. GERD is not usually a life-threatening condition, but it can be quite
unpleasant and some dangerous complications can develop if the disease remains
untreated. If you suspect that you may have GERD, see your doctor as soon
as possible.
OTHER
GASTROINTESTINAL DISEASE
Peptic ulcers, gas pockets, irritable bowel syndrome, esophageal spasm, a tear
or ulcer in the esophagus, or pain associated with pancreatitis can all lead
to chest pain of one kind or another. Click on the links in the third main
section of the page listed below for details on each of these conditions.
PLEURISY
Pleurisy is an inflammation of the moist, double-layered membrane surrounding
the lungs, most often caused by some kind of infection. The most prominent
symptom of pleurisy is considerable pain connected to breathing, particularly
if you experience sharp pain while taking a deep breath, your chest pain
may be the result of pleurisy. In such a case, you may also suffer from shortness
of breath. If you are not already undergoing treatment for an infection,
or another disease that can cause pleurisy (these include arthritis, lupus,
cancer, kidney disease, and heart failure), symptoms of pleurisy are sufficient
cause to visit your doctor, though not an emergency.
CARDIOVASCULAR
PROBLEMS
The most feared origin of chest pain is, of course, heart disease. A heart
attack or myocardial infarction, the most immediately lethal of all causes
of chest pain, are easily distinguished from other causes by the associated
symptoms: squeezing pain in the chest and upper left arm, sweating, nausea,
and shortness of breath. If you have any of those symptoms, contact the emergency
room immediately. A heart attack needn’t be fatal, provided emergency care
is administered promptly. Heart failure is another possible cause of chest
pain. Heart failure is a serious condition, with no known cure, but it can
be managed and survived. For a detailed list of the symptoms associated with
heart failure, along with an explanation of their causes, visit www.americanheart.org/
presenter.jhtml?identifier=339. Myocarditis, a condition in which the heart
muscle itself becomes inflamed, and pericarditis, inflammation of the membranes
that surround the heart, are closely related conditions and can both manifest
as chest pain. Myocarditis is often caused by a recent viral infection; diptheria,
tuberculosis, and toxic drug poisoning may also be culprits. Pericarditis usually
manifests as a sharp pain over the center or left side of the chest, and can
be associated with heart attacks (see below), radiation treatment, infection,
or recent surgery. Neither condition, on its own, is usually immediately fatal,
but treatment of the condition or problem (eg, the infection or heart attack)
that led to inflammation may be necessary.
ANGINA
Which leads us around at last to angina, more properly called angina pectoris,
a term describing a very specific type of chest pain that, as we’ve mentioned,
is often misappropriated to refer to chest pain in general. According to
the National Institutes of Health site devoted to the topic, angina is “a
recurring pain or discomfort in the chest, that happens when some part of
the heart does not receive enough blood. It is a common symptom of coronary
artery disease, which occurs when the vessels that carry blood to the heart
become narrowed and blocked due to atherosclerosis.” The symptoms of angina
are very similar to those associated with a heart attack, but usually do
not last for more than five minutes at a time. Patients with known coronary
artery disease may experience periodic bouts of angina, which occur subsequent
to known “triggers” (such as exertion or psychological stress); this is called “stable
angina.” When angina occurs outside of this known pattern, happens during
periods of rest or sleep, and/or is especially severe or long lasting, it
is considered “unstable angina,” and requires rapid emergency care.
MEDLINE offers a detailed tutorial on the subject of angina pectoris, in slide
show format with supplemental audio, available at www.nlm.nih.gov/
medlineplus/tutorials/angina.html. |
