After a brief lull, I am back again with a new but interesting topic. In my 35 years of Medical Practice, I have come across many patients who complained of chest pain and were quite worried about it. Most of them were not very serious to cause panic, but some were serious enough to warrant hospitalization. In this article, I will be outlining different categories of chest pain with an insight into its immediate management. So, here we go-
Many of us have had chest pain one time or the other and I am sure that most of you and your loved ones must have been scared to death that it must be a heart attack. Yes, it may be or maybe not. In this article, I am going to guide you to decipher that chest pain and if it is one of those things that you have, here’s what to do. Read on:
One patient visited my Clinic with a complaint of chest pain in the left half of the chest which aggravated on movement, bending forward and stretching the arms. I examined the patient. His pulse and heart sounds were normal, there was no sweating, BP was also normal and all other chest sounds like breath sounds were also normal. One putting pressure on the just left of the center of the chest, the patient cringed with pain. What was this? Well, this is a condition caused due to the swelling of the joint of ribs with the central chest bone called sternum and is called Costo-chondritis. On inquiry, the patient gave a history of lifting a heavy object 1 week back. This is what led to swelling of one of the costochondral joints and subsequently the pain after about 1 week. This is a fairly common condition causing chest pain and can be treated by hot fomentation and anti-inflammatory tablets.
The Rib fracture
A patient came to my clinic one day with a complaint of swelling and chest pain on the left side, aggravated by breathing. On examination, I could see a purple swelling at the site of pain. He had an accident the day before while driving a two-wheeler. X-ray chest was advised which showed fractured ribs. He was referred to the orthopedic surgeon for further treatment.
Inside our chest, we have 2 major organs- the lungs and the heart. The lungs are enclosed by 2 layers covering called pleura. In between inner[visceral] and outer[parietal] pleura, there is the pleural space which contains a fluid which helps lubrication when the lungs expand and contract while breathing. Sometimes due to some infections of the lungs, there is inflammation of the pleura, which has sensory nerves, which causes pain on breathing. This inflammation is called pleuritis. The picture shown above shows how the pleura looks after getting inflamed. Treatment is with antibiotics and anti-inflammatory drugs under supervision at the hospital.
Just as in pleuritis, there is a condition where the air gets trapped in between the pleura. This occurs suddenly with severe pain. The lungs on that side collapse and the patient become breathless. This patient needs urgent admission in hospital for removal of the trapped air.
Just as in the lungs, the human heart is covered by 2 layers called the pericardium. When there is inflammation of the pericardium, it is called Pericarditis. As the heart is pumping blood non- stop, there is rubbing of the 2 layers of the pericardium leading to a pain similar to a heart attack. There will be ECG changes also. Treatment is by getting admitted in a hospital under a cardiologist.
The Angina Pectoris
This is the most common chest pain of the heart which is a precursor to the heart attack. This pain occurs due to insufficiency of blood supply to the heart muscle due to a block developing in the coronary [heart] arteries, which supply oxygen to the heart muscle. The pain occurs mostly on exertion and reduces on resting. Accordingly, there are two types of angina pains, viz., A] Stable angina; B] Unstable angina. In Stable angina, the chest pain disappears on resting but in Unstable angina, the pain persists even at rest. Your doctor might give you a nitroglycerine tablet to be kept under the tongue, which dilates the arteries and improves blood supply to the heart muscle.
The Heart Attack
This is by far the most terrifying pain in the chest. The patient complains of severe crushing pain in the center of the chest just behind the breast bone, followed by excessive sweating, nausea/ vomiting and passing of stools without knowing it. Here he/ she may also complain of giddiness. His or her BP my be high or low. The treatment is the same as for pericarditis i.e. admission in a hospital where the Intensive Cardiac Care Unit is available.
The Aortic Aneurysm/Dissection
Aorta is a major blood vessel in the chest which supplies blood to all parts of the body through various branches. Diseases like tertiary syphilis[ a type of sexually acquired disease] can cause infection in the wall of the Thoracic aorta[part of aorta present in the chest], which, due to continuous pumping activity of the heart becomes thin and forms a balloon-like defect in the aorta, as shown below. If it goes unnoticed, it can burst which causes severe pain and death in most of the cases. If it is somehow detected accidentally on an investigation like echocardiography, surgery can prevent further events and save the life of the patient.
The Pulmonary embolism
This is a condition that occurs in a patient who has got a clot in the veins of the lower or upper limbs [also termed Deep Vein Thrombosis or DVT] and which got released in the venous circulation and got carried to the pulmonary ( lung) circulation. This is called embolism and leads to severe chest pain and lung infarction, that is, the death of that part of the lung. DVT of the lower limbs is common in hospitalized patients and in pregnancy. Again, this is an emergency and needs admission in hospital for further treatment.
Just before someone gets affected by pneumonia, there occurs swelling of the lungs parenchyma( lung tissue) and it appears like a haze in the x-ray. There is swelling of the airways leading to chest pain at this stage and later on, it leads to pneumonia. The above picture shows the changes in airways due to pneumonitis. This can happen as an allergy to inhaled chemicals, smoke, dust, etc. Your doctor will help you to get relief from pain and further progression of the disease.
The food pipe is called the esophagus. When there is reflux of acid from the stomach into the esophagus[also known as GASTROESOPHAGEAL REFLUX DISEASE OR GERD], the inner lining of the food pipe gets burned giving rise to inflammation and pain. The picture shown below explains how GERD occurs. This sort of pain is also called heartburn because it mimics a heart attack. Treatment consists of ruling out a heart attack and taking antacids advised by the attending physician.
- These are a few common but important causes of chest pain. There are many more causes such as cervical spondylitis, TB of the thoracic spine, herpes infection[shingles], etc. These causes are too vast to discuss presently and will be dealt with separately in future blogs.
- Kindly do not try treatment such as taking antacids. Contact your health provider or family physician and he/she will guide you properly.
In my next article, I will be talking on Arthritis-different types and their management. If you have any queries you may use my comments section to contact me and if you have your investigation reports to go with, I will be glad to assist you, free of cost, by assessing the report and by giving appropriate advice.