Chest Pain remains one of the most searched topics online by patients due to the fear and panic of Myocardial Infarction (Heart Attack). It is considered one of the most common and yet onerous clinical symptoms physicians come across in their everyday practices.
The highest frequency of chest pain population is mostly in the age category 40 to 65 years though there have been records among younger age groups, with obvious striking differences with regards to gender (male and female symptoms presentation).
The main goal and the obvious challenge is how critical it is for a clinician is to exclude life-threatening causes of chest pain which include triaging less frequent but urgent diagnoses of chest pain including acute coronary syndrome (Unstable Angina, NSTEMI and STEMI), pulmonary embolism, from more common but less urgent diagnoses such as angina pectoris, gastro-oesophageal reflux, musculoskeletal pain or anxiety especially in young adults.
To make this crucial differentiation as a medical emergency and institute appropriate management, Physicians depend on number of diagnostic measures involving good history taking of the patient, medical history, physical examination and past experience to establish a working hypothesis. Time is of essence to establish life-threatening conditions like acute coronary syndrome (ACS) in patients with acute-onset chest pain as well as rule out other serious cardiac conditions.
There are broad range of Chest pain accompanying symptoms including (Dizziness, Fatigue, Nausea, Shortness of breath, Sweating, Abdominal pain, etc. which aids in making the right diagnosis and treat accordingly.
High likelihood of ACS includes Chest pain with radiation to the arms or shoulders, Chest pain associated with exertion, diaphoresis, nausea or vomiting, Chest pain described as pressure or like a previous Heart Attack.
Low likelihood of ACS includes Pleuritic or positional Chest pain.
CHEST PAIN CAUSES AND DEFINITIONS
COULD THIS BE A CARDIAC (HEART) CAUSE?
Acute coronary syndrome (ACS) is a term comprising of cluster of cardiac conditions associated with abrupt, reduced blood flow to the heart. It includes Unstable Angina, NSTEMI and STEMI.
A heart attack occurs when the blood flow to a part of the heart is suddenly and completely cut off, usually by a blood clot resulting in cardiac cell death and following damaged heart tissue.
Unstable angina is an ACS in which there is myocardial ischemia without detectable myocardial necrosis. This occurs because blood supply to the heart muscle is typically reduced by atherosclerosis, the build-up of fatty plaque in the arteries that supply the heart.
Angina Pectoris occurs when the amount of blood flowing to the heart muscle cannot meet the heart’s demand for blood. That is, mismatch of myocardial oxygen demand and supply.
OTHER CARDIAC CAUSES OF CHEST PAIN
Pericarditis
Pericarditis is an inflammation of the (pericardium) sac covering the heart. Patients presents with chest pain like angina, with sharp, steady pain along the upper neck and shoulder muscle that may worsen when you breathe, swallow food or lie on your back.
Myocarditis
Myocarditis is heart muscle inflammation. Often, the chest pain is accompanied by fever, fatigue and difficult breathing.
Mitral Valve Prolapse
Mitral valve prolapse is a condition in which the heart’s mitral valve does not close properly.
Aortic dissection
Aortic dissection is rare but life-threatening condition that results when a tear develops in the largest artery in the body.
Syndrome X is cardiac microvascular (the heart’s tiniest arteries) dysfunction or constriction causing angina in patients with normal epicardial coronary arteries on angiography
NON-CARDIAC CAUSES OF CHEST PAIN
Gastrointestinal diseases (stomach ulcers, gastritis, heartburn, gastroesophageal reflux disease and gallstones)
Lungs causes of chest pain (blood clots, pneumonia and pleurisy, or swelling of the lining around the lung) or a collapsed lung
Panic attacks and Anxiety
Costochondritis is the Inflammation of the areas where the ribs connect to the breastbone.
Acute asthmatic attacks
Shingles
TAKE HOME NUGGETS FOR OUR READERS
ALWAYS TAKE CHEST PAIN SERIUOS REGARDLESS OF AGE (20 OR 80 YEARS OLD).
DO SPEAK TO A DOCTOR TO RULE OUT LIFE THREATENING CAUSES AS DISCUSSED ABOVE.
AS PHYSICIANS CHEST PAIN IS ALWAYS CONSIDERED CARDIAC IN NATURE UNTIL PROVEN OTHERWISE
WAITING OR TREATING YOURSELF COULD CAUSE DAMAGE TO YOUR HEART MUSCLES.
WOMEN MAY EXPERIENCE SHORTNESS OF BREATH, FATIGUE, SUDDEN WEAKNESS RATHER THAN THE TYPICAL CHEST PAIN. IT IS THEREFORE PRUDENT TO CONSIDER ANY SYMPTOMS SERIOUS TO ESCAPE FATALITIES. This medical article is intended for educational purposes and cardiovascular diseases advocacy.
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