Everything you need to know about chest pains and how to treat them

There are different types of chest pains – they can be sharp or dull, crushing or burning.

The pain can radiate to the neck, into the jaw and spread to the back or down one or both arms, most commonly the left arm.

There are many different causes of chest pain and the most life-threatening ones involve the heart or lungs. When you experience chest pain, it is best to consult a doctor quickly so that a diagnosis can be made.

Causes

The causes of chest pain may be related to the heart, digestive tract, muscles and bones or lungs. Heart-related causes of chest pain include:

• Angina. This is chest pain caused by a poor blood flow to the heart.

• Heart attack. A heart attack results from a blocked blood flow to the heart muscle, often from a blood clot.

• Aortic dissection. This is when the inner layers of this blood vessel (aorta) separate, blood is forced between the layers and can cause the aorta to rupture.

• Pericarditis. This is the inflammation of the sac around the heart. The condition usually causes sharp pain that gets worse when breathing in or lying down.

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Disorders of the digestive system include:

• Heartburn

• Swallowing disorders due to conditions in the oesophagus.

• Gallstones or inflammation of the gallbladder or pancreas.

Muscle and bone related causes include:

• Costochondritis which is when the cartilage that joins the ribs to the breastbone becomes inflamed and painful.

• Sore muscles of the chest.

• Injured ribs.

Lung related problems which can include:

• Pulmonary embolism, a blood clot in the lung which can block blood flow to lung tissue.

• Pleurisy is inflammation of the membrane covering the lungs. This causes chest pain that gets worse when you breathe in or cough.

• A collapsed lung occurs when air leaks into the space between the lung and the ribs and causes severe pain.

• Pulmonary hypertension is when the blood pressure in the lung arteries gets high and can cause chest pain.

Other causes of chest pain:

Chest pain can also be caused by:

• Panic attacks. The symptoms include chest pain, fast heartbeat and breathing, sweating, shortness of breath, nausea, dizziness and intense fear of dying.
• Shingles. This condition can cause intense pain.

Diagnosis

Chest pain is not necessarily a heart attack, but it could be life-threatening. It is also important to find out if there are any emergencies that need attention.

Some of the first tests a healthcare provider may order when diagnosing the cause of chest pain include:

• Electrocardiogram (ECG or EKG). This quick test measures the electrical activity of the heart.

• Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins.

• Chest X-ray. An X-ray of the chest shows the condition of the lungs and the size and shape of the heart and major blood vessels v Computerised tomography (CT) scan.

• CT scans can spot a blood clot in the lung or find an aortic dissection.
  
• Echocardiogram. Sound waves are used to create videos of the heart in motion.

• Stress tests. These tests of ten involve walking on a treadmill or riding a stationary bike while the heart rhythm is watched.

• Exercise tests help show how the heart reacts to exercise.

• Coronary catheterisation. This test helps healthcare providers see blockages in the heart arteries.

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Treatment

Chest pain treatment varies depending on what’s causing the pain.

• Artery relaxers. Nitroglycerin is usually taken as a tab let under the tongue which relaxes heart arteries so blood can flow more easily through the narrowed spaces. Some blood pressure medicines also relax and widen blood vessels.

• Aspirin. If healthcare providers think that your chest pain is related to your heart, you will likely be given aspirin.

• Clot-busting drugs, also called thrombolytics. If you are having a heart attack, you may receive these medicines. These work to dissolve the clot that is blocking blood from reaching the heart muscle.

• Blood thinners. If you have a clot in an artery going to your heart or lungs, you will likely be given medicines to prevent more clots from forming.

• Acid-reducing medicines. If chest pain is caused by stomach acid splashing into the oesophagus, a healthcare provider may suggest these medicines. They reduce the amount of acid in the stomach.

• Antidepressants. If you’re having panic attacks, your healthcare provider may prescribe antidepressants to help control symptoms.

• Surgery. If the above medication fails, there are surgical options that your doctor will refer you to a cardiologist for.

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