Chest pain is a pain in any area of chest; may spread to other areas, including down to the arms, neck or jaw. The most important issue is to decide whether the pain is a mere symptom of an illness or a disease in itself. It is sometimes difficult for a common man to distinguish between a symptom and a disease. Normally, a patient is always concerned with the symptom which is troublesome. On the other hand, it is the duty of the physician to find the cause of the symptom i.e. the disease responsible for the symptom.
Chest pain has a wide spectrum of quality, intensity,
duration & location. It could be vaguely or definitely located in some part
of the chest; sharp or dull in intensity and of variable character. A patient may feel tightness, achiness, or a
feeling that the chest is being crushed or squeezed. Sometimes, it is expressed
as sharp and stabbing pain while it is dull in other conditions. Duration of
chest pain usually depends upon the duration of the illness; it can last for a
few minutes or hours in some diseases while it can last for months or longer in
other conditions.
Patient’s perception about gravity of chest pain may vary. To some, it is a
warning of potential life-threatening illness and they may seek repeated
consultations even when the symptom is trivial. Others, including those with
serious illnesses, may tend to ignore. It is however important for a physician never
to discard the symptom without exploring its cause. Chest pain may arise due to
diseases of chest wall and spine, lungs, heart, great vessels, esophagus and
sub diaphragmatic structures and many other organs.
Cardio-vascular
diseases: Coronary Artery (Ischaemic) Disease: Angina, Myocardial Infarction,
Peri carditis & Pericardial effusion, Myo carditis, Cardio myopathies,
Aortic Dissection
Gastrointestinal causes: Heartburn & Acid
Reflux, Swallowing problems related to esophagus, Gallbladder & Pancreatic causes
Muscle- or bone-related: Sore muscles from exertion or
chronic pain syndromes, Bruised, broken ribs, Compression fractures (Spine)
Miscellaneous causes: Shingles; Anxiety and Panic attacks
To make a diagnosis, we need to look into history of duration, location,
radiation to other areas and character, i.e. heaviness, tearing, burning,
stabbing, sharp needle like, urge to eructate or merely a discomfort (dull ache
or boring). Precipitating factors of chest pain include physical or
psychological stress, respiratory efforts, coughing or swallowing, and
relieving factors (such as leaning forward). Other associated symptoms such as
ough, dyspnea, palpitation, syncope, diaphoresis, nausea, vomiting, fever and
chills, weakness, malaise and weight loss are also important.
Pain due to heart
attacks can be life-threatening. Other
signs of a heart attack include:
•
Sweating, Nausea or vomiting, Shortness
of breath, Light-headedness or fainting
•
A rapid or irregular heartbeat, Pain in
the back, jaw, neck, upper abdomen, arm or shoulder
Leg pain and swelling may point to deep vein thrombosis and pulmonary
thromboembolism.
Almost any lung disease
can cause soreness around the chest and muscle aches
Further tests will depends
upon clinical suspicion. It is best to follow the advice of you physician of
the best chest centre in the town.
Apart from good
clinical history, your physician will initially like to do Chest X-ray and
Electrocardiogram. Pulmonary evaluation includes Spirometry & other lung
function tests. Sometimes, CT Chest: CECT, CT Pulmonary Angiography may be
required. Cardiac Evaluation may include blood biochemistry, Echocardiogram,
Stress test, Angiography
It is important to manage health conditions such as
high blood pressure, high cholesterol and diabetes. One should also take care
to avoid risk factors (not using tobacco products; limiting the amount of alcohol); lifestyle
changes such as healthy diet and exercising.
