Causes of Chest Pain Other Than Heart Attack

Introduction:

When people get chest pain, most of them will panic about a severe problem with their heart. To what extent should one worry about it? Chest pain appears in many forms, varying from a sharp stab to a dull ache and crushing or burning. It can also vary in quality, intensity, duration, and location. In some instances, the pain from the chest can travel up the neck into the jaw and then to the back or down one or both arms. Before discussing the causes of chest pain, one has to be familiar with the general anatomy of the chest. The chest is formed by skin, subcutaneous fatty layer, chest wall muscles, ribs, pleura (a layer that covers the lungs), lungs, esophagus, heart, and neurovascular components.

What Is a Heart Attack?

When the blood flow to the heart muscle gets blocked due to a blood clot, it can cause chest pain. It can cause compressing chest pain, dull aching, and suffocating in nature, which usually radiates to the left shoulder, sometimes to the jaw, and causes epigastric pain. It is associated with risk factors such as smoking, diabetes, hypertension, high lipid profile, or family history. Seek medical advice immediately.

What Are the Common Causes of Chest Pain?

Chest pain can occur due to many reasons, but the two main groups of causes include:

• Cardiac causes.

• Non-cardiac causes.

Various problems can cause chest pain, but the pain caused by heart and lung problems is life-threatening and it requires immediate medical intervention.

Cardiac Causes of Chest Pain:

Cardiac-related causes of chest pain include:

• Angina: When the heart muscles receive insufficient oxygen-rich blood, it is called angina, leading to chest pain. It is a more dangerous and life-threatening condition. It is usually caused by blockage of the coronary arteries (blood vessels that supply blood to the heart) due to the accumulation of thick plaques on the inner walls of the arteries. These plaques in the arteries can cause them to narrow and restrict the blood supply to the heart, especially during physical activity.

• Aortic Dissection: The inner layers of the aorta (the major artery leading from the heart), when separated, can be torn due to the forcing of blood between the layers. When blood rushes through the tear, it can cause the aorta to split, which is often deadly. It can cause severe pain radiating to the back, central, associated with uncontrolled hypertension. Seek medical advice immediately.

• Pericarditis: The inflammation of the pericardium (sac or thin membrane around the heart) is called pericarditis. This condition can usually cause sharp pain over the center or left side of the chest while breathing in or lying down. The inflamed pericardium can cause persistent pain that increases with leaning forward, usually following an upper respiratory infection, but could be due to other severe kidney conditions. Seek medical advice if it is persistent to exclude more serious conditions.

Non-Cardiac Causes of Chest Pain:

1. Herpes Zoster: This pain can be burning in nature, and the pain will occur before the skin rash appears. It is associated with red skin vesicles grouped in one site, usually seen in elderly persons but also familiar in young people with stressful conditions. It is treated conservatively, but sometimes pain medications help.

2. Breast Abscesses in Females: A red, tender, swollen lesion seen in some lactating mothers. An elective outpatient clinic visit is required, and it is usually treated with antibiotics for a few days.

3. Gynecomastia: The swelling of the breast tissues in males due to hormonal imbalance in boys or men is called gynecomastia. It is a palpable tender disc under the nipples of males. It is more common in adolescents. An outpatient clinic visit is required in this case, and it is usually treated conservatively.

4. Musculoskeletal: It is a stabbing type of pain, very annoying, and is associated with tenderness, usually following trauma, abrupt, violent movement, uncomfortable sleeping position, or exposure to extreme cold weather. Treated conservatively, pain medications (systemic or local) could help depending on the severity.

5. Pleurisy: The inflammation of the membrane covering the lungs can cause chest pain and can worsen when one inhales or coughs. Pleurisy can cause a stabbing, localized pain that develops following a common cold or simple chest infection. Management is with some painkillers if needed.

6. Gastric Reflux: Central burning chest pain is seen after eating a meal, which is very common in obese people. Antacids relieve the pain, and so does changing the eating habits.

7. Pulmonary Embolism: When a blood clot gets stuck in a lung (pulmonary) artery, it can block blood flow to lung tissues, which may lead to chest pain.

8. Collapsed Lungs (Pneumothorax): When the air enters the pleural cavity (the space around the lungs), it can cause collapsed lungs. The pain in the chest can begin suddenly and last for hours, causing difficulty in breathing.

9. Pulmonary Hypertension: This condition of high blood pressure in the lung arteries is called pulmonary hypertension. It can affect the arteries carrying blood to the lungs and produce chest pain.

10. Injured Ribs: Broken or bruised ribs can cause chest pain.

What Are the Other Conditions That Can Be Associated With Chest Pain?

• Atherosclerosis is a buildup of fat.

• Aortic stenosis is the thickening and narrowing of the valve.

• Cardiomyopathy is a condition that affects the heart muscles.

• Cholecystitis is the inflammation of the gall bladder.

• Shingle is a viral infection that results in rashes.

• GERD occurs when the stomach acid flows backward.

• Scleroderma is an autoimmune condition that causes skin inflammation.

• Cocaine use.

• Diabetes.

• Spasm of the esophagus.

• Polyarteritis nodosa is an inflammatory blood vessel condition.

• Gastritis is the inflammation of the stomach lining.

• Hiatal hernia is a condition that pushes the stomach through the diaphragm.

• Hypercholesterolemia is increased cholesterol in the blood.

• Hypertension.

• Hyperthyroid.

• Lupus.

• Marfan syndrome is an inherited condition that affects the connective tissue.

• Pott disease is a condition of extrapulmonary tuberculosis.

What Are the Symptoms that Require ER Visit?

It is not always chest pain related to a heart condition, although one should be aware of the following warning symptoms requiring a quick ER visit.

• Compressing chest pain is associated with effort, radiating to the left shoulder or jaw.

• Epigastric compressing pain associated with effort.

• Severe tearing central chest pain radiating to the back.

• Any chest pain associated with syncope, racing heartbeats, excessive sweating, or vomiting.

• Any suspected chest pain in a patient with risk factors (diabetes, hypertension, smoking, high lipid profile, or family history of cardiovascular diseases).

How Will the Person Know if the Chest Pain Is Serious?

The person will not be able to differentiate between a heart attack and non-cardiac chest pain. So, any chest pain needs to be considered seriously. If sudden pain lasts for more than five minutes, the person should be taken to the emergency room. If the chest pain subsides within five minutes, it may not be a serious condition, but the person needs to consult a doctor regarding the same.

Conclusion

Noncardiac chest pain can be frustrating and scary when it feels like a heart attack. Recurring episodes of noncardiac chest pain can interfere with the regular activity of the person. Any form of chest pain should be taken seriously, and the cause of the chest pain needs to be ruled out. This condition can be treated by knowing the underlying cause.