Chest Injuries

Chest Injuries 2016-11-03T08:24:07+00:00
chest pain

What Is Chest Pain?

Symptoms of chest pain, or angina, are quite common among the general population. Recent prevalence estimates have indicated that between 20 and 40% of all adults will experience symptoms of chest pain at some point during their lifetime. Moreover, around 1.5% of adults will visit their primary care physician each year with complaints of chest pain, while more than 5% of all emergency department visits are attributable to chest pain.

There are a wide variety of conditions associated with symptoms of chest pain. These can range from musculoskeletal, gastrointestinal, cardiac, psychological, and pulmonary conditions, to malignant diseases. Symptoms of chest pain that occur as the result of life-threatening cardiac disease is of immediate concern, though generally only accounts for between 8% and 18% of instances of chest pain.

Some of the more commonly reported symptoms of chest pain related to cardiac disease or other heart problem include:

  • Tightness, pressure, or fullness in the chest
  • Heart palpitations or racing heart
  • Pain that radiates to the shoulders, arms, back, neck, or even jaw
  • Moderate to severe pain that persists for longer than a few minutes
  • Pain or discomfort that worsens with physical activity
  • Pain or discomfort that persists while at rest
  • Shortness of breath
  • Weakness or feeling dizzy
  • Nausea or vomiting
  • Cold sweats

It is important that you call 911 or seek immediate medical attention if you are experiencing any of the above symptoms.

It is not uncommon for physicians to be unable to identify the specific underlying cause for a patient’s symptoms of chest pain or discomfort. This can be quite distressing for the patient and their family, given the concern of heart disease. Nonetheless, there are a number of non-life-threatening conditions that can lead to symptoms of chest pain or discomfort.

Some of the most commonly reported symptoms that are likely not indicative of an underlying heart condition include:

  • Sour taste in the mouth
  • Difficulty swallowing or regurgitation of food
  • Pain or discomfort that becomes worse when shifting position of the body
  • Pain that worsens when taking a deep breath or coughing
  • Tenderness of the chest

Causes Of Chest Pain

There are a number of conditions that are associated with symptoms of chest pain or discomfort, which are discussed in more detail below.

Cardiac Conditions

Conditions that affect the structures that comprise the circulatory system can cause symptoms of chest pain. For instance, individuals who are having a heart attack will commonly report symptoms of pressure or tightness of the chest, compression, and moderate to severe symptoms of pain. Individuals suffering from a heart attack may also describe that their symptoms of pain and discomfort will radiate out from the chest area to the shoulder, arm, back, or even jaw.

Individuals who have suffered an aortic dissection, which is characterized by a lesion in the wall of the large blood vessel that transports blood from the heart to other areas of the body, commonly report symptoms of very severe pain within the chest or upper back region that occurred quite suddenly. Finally, individuals with pericarditis will commonly report symptoms of pain that emerge within the center of the chest area. Pericarditis is a condition characterized by irritation and inflammation of the pericardium, which is the fibrous membrane that surrounds the heart. It should be noted that cases of chest pain reported by children do not tend to be associated with an underlying cardiac condition.

Pulmonary Conditions

There are several conditions affecting the lungs that may lead to symptoms of chest pain or discomfort. For instance, pulmonary embolism, which is characterized by a blood clot located within the lung, can lead to significant symptoms of pain. A collapsed lung, also known as pneumothorax, may be associated with chest pain. Chest pain that is sharp and worsens upon inhaling deeply or coughing may be attributable to pneumonia, which is caused by inflammation of the microscopic air sacs within the lungs, known as alveoli. This inflammation is generally the result of an infection of fungi, bacteria, or a virus within the lung. Finally, the lining of the lungs can become irritated and inflamed, which is known as pleurisy, and leads to symptoms of sharp pain in the chest similar to that of pneumonia.

Gastrointestinal Conditions

Chest Wall PainSymptoms of chest pain and discomfort can be attributable to conditions affecting the digestive system. For instance, pain that worsens after a meal, particularly a meal high in fat, may be associated with gallstones. The esophagus, which is the channel that transports food from the mouth to the stomach, can be the source of chest pain, should it begin to spasm or narrow. Acid from the stomach can also back up into the esophagus and cause irritation and pain. This condition is known as gastroesophageal reflux disease (GERD) and is commonly referred to as heartburn. Finally, stomach ulcers or gastritis, which is an irritation or inflammation of the stomach lining, can also lead to symptoms of chest pain.

Treatments For Chest Pain

There are a variety of treatments available to manage symptoms of chest pain and discomfort. Your doctor will determine which treatment options are appropriate for you based on the underlying source for your pain.

There are several medications available that may be used to effectively manage your symptoms of chest pain.

  • Blood vessel relaxers: The most commonly used medication for relaxing the arteries of the heart is nitroglycerin. This permits blood to flow more freely through the narrow spaces of the blood vessels. Some blood pressure medications have been reported to also lead to a relaxation and widening of the blood vessels within the body.
  • Aspirin: In most instances, when the underlying source for the pain is attributable to a cardiac condition, your doctor will recommend that you begin taking aspirin.
  • Thrombolytic therapy: This treatment involves injecting a clot-busting drug intravenously, which acts to break up any existing blood clots.
  • Blood thinners: Blood thinners are generally recommended for individuals who are diagnosed with a blood clot located near where an artery feeds into the lungs or heart. These drugs act by preventing the formation of additional blood clots.
  • Acid-suppressing medications: Acid reducers are typically prescribed to individuals who are suffering from chest pain or discomfort that is associated with a backflow of stomach acid within the esophagus.
  • Antidepressants: In some instances, the symptoms of chest pain and discomfort are associated with a panic attack and, thus, are prescribed an antidepressant in order to control these symptoms.

Depending on the underlying condition, your physician may recommend a course of physical therapy to help ease the effects of chest pain. Physical therapy is a series of specified stretches and exercises that aim to increase flexibility and strengthen muscles of the core and back. A very small portion of cases continue to report symptoms of moderate to severe chest pain, which may not have responded adequately to medication.

Though uncommon for the treatment of chest pain, corticosteroid injections or even nerve blocks may be recommended to provide the patient with some reprieve. These more interventional approaches are not indicated in all instances of chest pain. For instance, some epidural injections and nerve blocks may actually result in conditions leading to chest pain. Intercostal nerve blocks, for example, are delivered at the chest under the ribs. Risks for this procedure include incidental lung puncture and lung collapse, which can lead to significant symptoms of chest pain. As such, it is important for patients to discuss their pain symptoms with their doctor.

For more serious causes of chest pain or discomfort, there are more invasive procedures available. In instances where the individual’s symptoms of chest pain and discomfort are associated with a blockage within an artery that feeds to the heart, the physician will insert a narrow tube into a large blood vessel within the groin region, guiding it up to the blockage. Once the tube is in the proper place, the physician then inflates the balloon, which thereby reopens the artery. In a portion of cases, a small mesh tube is placed within the artery to keep it open. This is known as balloon or stint placement. Bypass surgery is another procedure typically used to treat instances of blood clots. During this procedure, a portion of blood vessel is removed from another area of the body and placed as an alternative route around the blocked portion of blood vessel.

Individuals who have suffered from an aortic dissection will require emergency surgery for a dissection repair, as there is a high risk for the artery that transports blood away from the heart and to the other parts of the body to rupture. Finally, and similar to balloon therapy, individuals suffering from chest pain and discomfort as the result of collapsed lung will generally require treatment for lung re-inflation.

Conclusion

Symptoms of chest pain or discomfort can be very distressing, as there is some chance that they are associated with a life-threatening heart condition. However, cardiac conditions that require more immediate treatment comprise less than 20% of the total instances of chest pain. These symptoms can occur as the result of any number of conditions, such as cardiac, musculoskeletal, gastrointestinal, psychological, pulmonary, and malignant diseases. Treatment for these symptoms depends largely on the individual’s specific underlying condition. Individuals are encouraged to speak with their physician regarding their symptoms of chest pain or discomfort.

References

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  5. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2007;116:803-877.
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