By Dr Joel Enejeta
Chest pain is a common symptom experienced by many people sometime in their life. The cause sometimes is usually as a result of problems arising from the heart but can also arise from other structures in the chest such as the oesophagus.
Any pain from the chest should be taken serious although some causes might not be life-threatening but prompt care should be taken anytime you experience any form of chest pain. Any severe or persistent pain should be discussed with your doctor.
In this article, I will highlight on some of the most likely causes of chest pain.
COMMON CAUSES OF CHEST PAIN
Causes of chest pain are numerous. Below are brief overview of some of the more common causes.
ANGINA
Angina is a pain that originates from the heart. It is usually as a result of narrowing of blood vessels that supplies the heart muscles. This narrowing may be due to formation of plaques (fatty patches) in the lumen of the blood vessel over a significant period of time. If this narrowing is severe enough to compromise the rate of blood flow, pain arises when your heart works harder such as in exercise. Activity makes the heart work harder, and when this occur, the heart needs more oxygen to be able to pump blood, as a result of the narrowing of the blood vessels, there is limited flow of blood to the heart muscles causing hypoxia and subsequent pain.
The chest pain caused by angina may feel like an ache, discomfort or tightness across the chest on exertion, this pain may radiate to the shoulder, jaw or neck. This pain may disappear within some minutes when you rest.
MYOCARDIAL INFARCTION (HEART ATTACK)
Heart attack is as a result of total blockage of blood vessels supplying the heart (coronary arteries). As in angina, this blockade may be as a result of atheroma (fatty plaques) which block the lumen of blood vessel supplying some part of the heart. When the duration of this blockade occurs in a significant length of time, it causes the death of the heart tissues supplied. This dead tissue in the heart is known as myocardial infarction. This condition is a medical emergency and prompt treatment might relieve the blocked vessel preventing infarction of the part supplied.
The most common symptom of heart attack is severe chest pain at rest. It often feels like a heavy pressure feeling on the chest. The pain may radiate to the jaw, down to the left arm or down both arms.
GASTRO-OESOPHAGEAL REFLUX DISEASE
This is a general term which describes a range of situations including:
Acid reflux – when acid leaks up (refluxes) from the stomach into the gullet (oesophagus).
Oesophagitis – when there is inflammation of the lining of the oesophagus. This inflammation is due to irritation of the lining caused by the reflux of stomach acid.
When we eat, food passes down the oesophagus into the stomach. Usually a band of muscle (a sphincter) at the bottom of the oesophagus prevents acid reflux from the stomach back up into the oesophagus. If this sphincter is not working well then acid reflux can occur.
Heartburn is the main symptom of gastro-oesophageal reflux disease. This is a burning feeling that rises from the upper abdomen or lower chest towards the neck. Other common symptoms include pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching and a burning pain when you swallow hot drinks. The symptoms tend to come and go and to be worse after meals. Severe chest pain can develop in some cases and can be mistaken for a heart attack.
STRAINED CHEST MUSCLES
There are various muscles that run around and between the ribs to help the rib cage to move during respiration. These muscles can sometimes be strained and can lead to chest pain in that area. If a muscle is strained, there has been stretching or tearing of muscle fibres, often because the muscle has been stretched beyond its limits. For example, a strained chest wall muscle may sometimes develop after heavy lifting, stretching, sudden movement or lengthy (prolonged) coughing. The chest pain is usually worse on movement and on breathing in.
ANXIETY
Anxiety is quite a common cause of chest pain. As well as feeling fearful, worried and tense, anxiety can sometimes cause physical symptoms including chest pain. In some people, the chest pain can be so severe that it is mistaken for angina. Chest pain due to anxiety is known as Da Costa’s syndrome. Da Costa’s syndrome may be more common in people who have recently had relatives or friends diagnosed with heart problems, or in people who themselves have recently had a heart attack. Investigations show that the coronary arteries are normal with no narrowing.
OTHER CAUSES INCLUDE
Pneumothorax
Pulmonary embolism
Peptic ulcer
Shingles
Pleurisy.