Chest Pain – When Should You Be Worried ?

Chest pain, tightness and discomfort in the chest area is certainly something you cannot ignore. But why does chest pain actually occur ?

In healthy people during sports activities, pain occurs mainly as a result of direct trauma to the chest area or due to overloading the body and the chest muscles, especially the intercostal muscles.This pain lasts for days and weeks and stops when taking analgesics.

Also, chest pain can be of emotional origin in people who are under psychological stress, and anxiety. Such chest pain is constant, lasts for hours, even days, and is not accompanied by other problems.

However, chest pain is most commonly associated with the heart. One of the most serious is anginal pain, a symptom of ischemic heart disease. Myocardial ischemia happens when there is an inadequate supply of the heart muscle with blood and oxygen. Permanent ischemia progresses to myocardial necrosis, a condition known as acute myocardial infarction.

However, there are various types of chest pain, that vary both by pain characteristics as well as pain causes. The most important thing is not to ignore the problems that occur, and seek medical attention in time.

Various chest pain-characteristics

Typical anginal pain is blunt pain, often described as constriction, burning, annealing that lasts up to 10 minutes or longer, and is localized behind the sternum. It tends to expand into the neck, shoulders, arms, back (between shoulder blades) or abdomen (but never below the navel!), And is most often accompanied by sweating (“cold sweat”), vomiting, nausea, and rarely loss of consciousness.

When it comes to stable angina pectoris, the pain usually occurs during physical strain, when going out in the cold, after a heavy meal or when bending forward (eg tying shoes, changing a tire on a car), as well as during daily activities that require keeping the arms up. After taking some rest or after taking therapy, the pain stops.In the unstable form of this condition, the pain can occur at rest or during sleep (usually in the morning).

There are certain risk factors that increase the likelihood of developing some conditions and illnesses. In the case of angina pectoris these the factors can be: high blood cholesterol, high blood pressure, diabetes, smoking, obesity, physical inactivity or a positive family history for coronary disease.

The diagnosis of anginal pain can only be made on the basis of medical history and a characteristic ECG with typical changes for cardiac muscle ischemia.

However, a normal ECG finding in the presence of symptoms of angina pectoris is a warning,  and suggests that further diagnostics should be made, without excluding a coronary nature of the pain.

Other Causes Of Chest Pain:

1. Dissecting aortic aneurysm

Characterized by sudden, sharp, tearing pain that can spread down the path of dissection. Loss of consciousness may occur.

2. Pulmonary thrombo-embolism

Characterized by piercing pain, which is worsened by the inhalation of air, followed by rapid breathing, rapid heart beating, bluish discoloration of the lips and peripheral parts of the body.

3. Inflammation of the heart muscle (acute myocarditis) and inflammation of the heart tissue (pericarditis)

These two conditions cause aches and pains that typically change with respirations and posture changes.

4. Untreated hypertension and the hypertensive crisis 

These are a common cause of pain that stops after normalizing blood pressure, usually after therapy

5. Heart rhythm disorders

They can feel like short chest pain.

6. Pulmonary causes of chest pain

These can be pneumothorax, pleuritis, pneumonia (lungs inflammation), etc. Pleural pain is also connected to the respiratory cycle and body posture, with characteristic shallow breathing.

7. Inflammatory or degenerative processes in the musculoskeletal system

they are characterized with superficial pain, which can be alleviated by massage.

Esophageal diseases (gastroesophageal reflux, esophagitis), gastritis, ulcer disease, hernia hiatus can sometimes produce pain in the chest epigastrium. This pain is never provoked by physical effort.

Today, while living stressful lives and struggling for existence, we are a subject to the effects of a stressful environment, and we should not neglect the signs sent by our body. Chest pain is a symptom that should not be ignored. The most important thing is to locate the problem (if there is one) and solve it on time.


References :

Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors (2016). Chest pain. In: Harrison’s Principles of Internal Medicine. 19th ed. NY: McGraw-Hill Inc. 137-140.

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