Management of Chest Pain

Published February 19, 2019

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Dr Rotimi Adesanya

Chest pain is a common symptom in daily family practice . It can be a symptom of different conditions , some of which are more serious than the others . It is best to seek medical attention for chest pain and to check if it is heart – related .

Common causes of chest pain

Indigestion or reflux ( heartburn) – when stomach acid comes up the food pipe , and causes a burning pain in the chest .

Inflammation – where the ribs join the breast bone known as Costochondritis chest infections , such as bronchitis and pneumonia .

Angina – pain caused by poor blood flow to the heart muscle , which usually occurs when the heart has to work harder than usual with exercise , anxiety or high emotion , cold weather or after eating a large meal , for example . The pain is usually short- lived and eases with rest .

Heart attack – when the blood flow to a part of the heart muscle is blocked. Chest pain caused by a heart attack usually does not go away with rest , and urgent medical attention is necessary

Anxiety and panic attack . This may also cause dizziness , heart palpitation , sweating and breathlessness , which can last up to 20 minutes .

Shingles ( herpes zoster ) – this is an infection that typically causes pain before a skin rash appears .

Mastitis , usually caused by a breast infection related to breastfeeding .

Inflammation of the gallbladder

Stomach ulcer

Pulmonary embolism – this refers to a blockage in the blood vessel that carries blood from the heart to the lungs . You may have sharp , stabbing chest pain that becomes worse when you breathe in.

Pericarditis – this is an inflammation of the sac surrounding your heart .

Chest pain has a number of causes , some of which may be minor , such as indigestion . Other more serious causes can include angina , heart attack or pulmonary embolism ( blood clot on the lung) .

Angina is pain or discomfort that happens when your heart can ’t get enough blood and oxygen . Angina is caused by coronary heart disease. Over time a fatty material called plaque builds up in your coronary arteries , thereby making them to become narrow. This reduces the blood flow to your heart and sometimes it may not get as much blood as it needs .

Stable angina : Stable angina is chest pain that can occur during physical activity or extreme emotion .

Unstable angina : Unstable angina is chest pain that occurs suddenly and becomes worse over time. It happens seemingly without cause . You may be resting or even asleep.

Prinzmetal angina: Prinzmetal angina ( coronary artery spasm ) is a temporary discomfort or pain caused by a spasm ( constriction) in one or more of your coronary arteries , which can block the blood supply to your heart muscle . Spasms can range from very minor to severe , and sometimes , they may completely block the blood supply to your heart . Angina is not a heart attack , but it is an indicator that you are at high risk of having a heart attack .

Symptoms

Angina causes pain or discomfort that usually feels tight , gripping or squeezing . It can vary from mild to severe . People feel angina in many different ways :

You may feel angina in the centre of your chest .

It may spread to your back , neck or jaw. It may also spread to one or both shoulders , arms or hands .

You might feel it in other parts of your body , but not in your chest.

You may not even have pain , but get an unpleasant feeling in your chest or feel short of breath .

People can have symptoms at different times . Some get them early in the morning or when resting or sleeping . Some get angina in cold weather after a heavy meal or after physical activity .

Laboratory Investigations

Cholesterol checks , glucose tolerance tests , regular blood pressure tests , stress test or a health check .

Prevention

Some of the following may help to reduce or eradicate chest pain : Stop smoking , eat a healthy balanced diet , exercise within your limits , lose weight if needed , reduce stress , do not take recreational drugs , avoid excessive amounts of alcohol , take medications as prescribed, such as a simple pain reliever or aspirin .

If you suffer chest pain that feels like a choking or heavy pressure , pain radiating to the neck / jaw/ shoulder/ arm and nausea /vomiting accompanied by pain , sweating or clammy to touch and shortness of breath , they could be signs of an imminent heart attack . Please call an ambulance or seek help .

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