Symptom - Chest pain

Definition:

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

Alternative Names:

Chest tightness or pressure; Chest discomfort

Considerations:

Like many people with chest pain, you may fear a heart attack. However, there are many possible causes of chest pain. Some causes are mildly inconvenient, while other causes are serious, even life-threatening. Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves.

If your chest pain is new or different from previous episodes of chest pain, you should be evaluated by a healthcare provider right away. This is especially true if you have any symptoms suggestive of a heart attack.

Symptoms of a heart attack -- call emergency or 911

• You would describe your pain as a pressure, squeezing or tightness in the chest.
• Your pain radiates to your jaw, left arm, or between your shoulder blades in your back
• You have any sweating, nausea, dizziness, palpitations (a feeling of a racing heart), or shortness of breath.

Take these symptoms even more seriously if you have risk factors for heart disease like family history, cigarette smoking, high cholesterol, high blood pressure, diabetes, or cocaine use.

Angina

Common Causes:

Other causes of chest pain include:

• Asthma, which is generally accompanied by shortness of breath, wheezing, and, sometimes, a cough.
• Other lung-related problems, such as pneumonia, a blood clot to the lung (pulmonary embolism), the collapse of a small area of a lung (pneumothorax), or inflammation of the lining around the lung (pleurisy). In these cases, the chest pain often worsens when you take a deep breath or cough and usually feels sharp.
• Muscle strain or inflammation of the muscles and tendons between the ribs.
• Anxiety and rapid breathing.

Chest pain can also be related to problems with your digestive system, including a stomach ulcer, gallbladder disease or gallstones, indigestion, heartburn, or gastroesophageal reflux (when the acid from your stomach backs up into your esophagus). Ulcer pain burns if your stomach is empty and feels better with food. Gallbladder pain often gets worse after a meal, especially a fatty meal.

In children, most chest pain is not caused by the heart.

Home Care:

If injury, over-exertion, or coughing have caused muscle strain, your chest wall is often tender or painful when you press a finger at the location of the pain. This can often be treated at home. Try over-the-counter pain medications (like acetaminophen or ibuprofen), ice, heat, and rest.

If you know you have asthma or angina, follow the instructions of your doctor and take your medications regularly to avoid flare ups.

Call If:

Call your local emergency number (such as 911) if:

• You have sudden onset of crushing, squeezing, tightening, or pressure pain in your chest.
• Your chest pain is associated with shortness of breath, an irregular pulse, sweating, dizziness, or nausea.
• You know you have angina and your chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual. You must also call 911 if your angina symptoms occur at rest.
• You have sudden onset of sharp chest pain with shortness of breath. This is especially true if such symptoms begin after a long trip, a stretch of bedrest (for example, following an operation), or other lack of movement that can lead to a blood clot in your leg.

Call your doctor if:

• You have a fever or a cough that produces yellow-green phlegm.
• Your chest-wall pain persists for longer than 3 to 5 days.

What To Expect:

Emergency measures will be taken, if necessary. Hospitalization will be required in difficult or serious cases or when the cause of the pain is unclear.

The doctor will perform a physical examination and monitor your vital signs (temperature, pulse, rate of breathing, blood pressure). The physical examination will focus on the chest wall, lungs, and heart. Your doctor may ask questions like the following:

• Is the pain between the shoulder blades? Under the breastbone? Does the pain change location? Is it on one side only?
• How would you describe the pain? (Severe, tearing or ripping, sharp, stabbing, burning, squeezing, constricting, tight, pressure-like, crushing, aching, dull, heavy)
• Does it come on suddenly? Does the pain occur at the same time each day?
• Is the pain getting worse? How long does the pain last?
• Does the pain go from your chest into your shoulder, arm, neck, jaw, or back?
• Is the pain worse when you are breathing deeply, coughing, eating, bending?
• When you are exercising? Is the pain better after you rest? Is it completely relieved or just less pain?
• Is the pain better after you take nitroglycerin medication? After you drink milk or take antacids? After belching?
• What other symptoms are also present?

Diagnostic tests that may be performed include:

• Blood tests (such as LDH, LDH isoenzymes, CPK, CPK isoenzymes, Troponin, CBC, and blood differential)
• Cardiac catheterization
• ECG
• Exercise ECG
• Lung scan
• X-rays of the chest

More complex tests may be required depending on the difficulty of diagnosis or the suspected cause of the chest pain.

Disclaimer:

Review Date: 8/5/2003
Reviewed By: Jacqueline A. Hart, M.D., Senior Medical Editor, A.D.A.M., Inc. Previously reviewed by Debbie Cohen, M.D., Renal and Electrolyte Division, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network (5/21/2002).