What Causes Chest Pain?

Introduction

Having a restful day, and still experiencing mild or severe chest pain, what could be the cause? Do not worry. This article will answer your question. Read more to know the possible causes of chest pain, its treatment and management.

Common causes of chest pain

Chest pain describes any pain felt in the upper area of your belly up to the lower region of the neck. Chest pain can be nothing serious but may be an underlying symptom of a serious health condition such as heart attack, gastrointestinal disease, lung disease or depression.  ^(1,2)

Types of chest pain

Chest pain can be experienced as a burning sensation or tightness in the chest region. The pain can be sharp, mild, achy or crushing. ⁽⁵⁾

Depending on the cause of the chest pain, chest pain is categorised into angina, non-cardiac chest pain and other various types.

Heart problems and chest pain

Chest pain is one of the most significant symptoms of heart disease. Chest pain caused by a heart problem is called angina. It is described as a condition when the arteries are not supplying enough oxygen-rich blood to the heart muscle. And it is experienced as a feeling of pain in the chest region. The American Heart Association (AHA) pointed out that angina is not a disease but a symptom of a heart disease known as coronary heart disease, which is more prevalent in women than men. Heart attack is characterised by chest pain, breathlessness, nauseous feeling, sweating and pain from the chest spreading to the arms, jaws and shoulders. Smoking, diabetes, obesity and excessive alcohol consumption increase one’s risk of heart disease. There are various types of angina, including stable, unstable, variant and microvascular angina. ^{(6, 9, 10, 12, 13, 14, 15)}

Stable angina is the most common type of angina. It is a symptom of coronary heart disease and is a condition that occurs when the heart muscle is supplied with less blood than it needs. Stable angina happens during physical activity and when one is emotionally stressed; it is experienced for a short time, like 5 minutes. It goes away quickly when resting or taking appropriate medications prescribed by your health provider.

Unstable angina is experienced as an unexpected or sudden chest pain that often occurs while resting or during mild physical activity. Unstable angina occurs due to narrowed arteries caused by fatty build-up in the blood vessel - atherosclerosis. ^{(25) Pain medications do not relieve unstable angina.}

Microvascular angina describes chest pain that lasts between 10 minutes and 30 minutes because of spasms in the small arteries, resulting in reduced blood volume supply to the heart muscle. It often happens during normal daily activities. And it can be accompanied by sleeping problems, shortness of breath etc. It can also be a symptom of coronary microvascular disease. ⁽²⁶⁾

Variant Angina occurs at midnight and during the early hour of the day (around 8 am); it is a severe pain caused by a spasm in the coronary artery, which medication can help relieve. Exposure to extreme weather conditions, cold/hot, cocaine consumption and smoking increase your risk of developing variant angina.  

Other heart problems that cause chest pain include: ^(3,5)

Pulmonary embolism is a blockage in the artery that carries blood away from the heart to the lungs. It is characterised by chest pain, swelling of the leg’s calf region and is sometimes accompanied by severe coughing of blood and shortness of breath.

Pericarditis refers to the inflammation condition of the sac around the heart. When this happens, the chest pain experienced can be sharp or dull, which usually worsens when lying down.

Other possible causes of chest pain

Chest pain not caused by heart disease is referred to as non-cardiac chest pain, and according to Cleveland Clinic, 25 per cent of adults in the United States have had at least an episode of non-cardiac chest pain. ⁽¹¹⁾ Health conditions that can cause non-cardiac chest pain are explained below.

Gastro-oesophageal reflux disease (GORD) 

Chest pain that starts after eating and brings up a bitter taste in the mouth with bloating feeling is caused by GORD. ^(3,16) GORD is when the stomach acid comes up through the oesophagus, causing a burning sensation in the chest region and a bitter taste in the mouth. Pregnancy, smoking, consuming fatty or spicy food, and obesity increase your risk of having GORD. Antacid medications can help relieve the symptoms.

Bone and muscle problems

A strained muscle in the chest region makes it painful and tender to touch. The pain goes away with having enough rest, and the muscle gets healed.

A condition called costochondritis, which is characterized by the inflammation of the cartilage present in the joint connecting the rib to the breastbone. ⁽¹⁷⁾ It is often accompanied by sharp or sudden chest pain that worsens when lying down, and pressure is applied to the chest when coughing or during physical exercise. The condition can be managed and treated with painkillers and medications prescribed by your health provider.

Anxiety and panic attacks 

Anxious feelings or a stressful situation can trigger chest pain. This panic or anxiety attack can also cause increased heartbeat, dizziness and sweating. Anxiety attacks can last about 5 to 20 minutes; psychological therapies and medications can address these attacks. ^(3,5)

Lung conditions 

Sharp pain in the chest that gets worse when breathing in and out and probably accompanied by coughing and shortness of breath with high temperature may be caused by lung conditions/chest infection. Examples of lung conditions that can cause chest pain include pneumonia (inflammation of the tissues around the lungs) and pleurisy (swelling of the tissue found between the lungs and rib cage). ^(3,8)

These two conditions in the lungs are usually caused by either viral or bacterial infection. Less severe pneumonia can be treated and managed by taking enough fluids, rest and prescribed antibiotics. Pleurisy caused by viral infection mostly resolves on its own. On the other hand, the one caused by bacterial infection is usually treated with antibiotics.

Pleurisy can be diagnosed through chest X-rays, blood tests, a biopsy and an ultrasound scan. Get immediate medical help when you have symptoms like coughing out blood, severe chest pain and high temperature.

Mastitis

Mastitis is an infection of the breast tissue that causes swelling and pain in the breast. It is usually experienced by breastfeeding mothers ⁽¹⁸⁾.

Chest trauma

Chest trauma causes chest pain after chest injury or chest exercise, and you get better after resting adequately.

Stomach ulcers and acute cholecystitis 

Stomach ulcers (burning pain in the tummy) and acute cholecystitis (gallbladder inflammation) cause pain in the tummy that spreads to the shoulder. ^(19,20)

Treatment 

Chest pain is not a disease but can be a symptom of an underlying health condition, so it is best to consult your GP and get treated. ^(5,7) Treatment for chest pain depends on the underlying cause of the pain.

Angina treatment: Treatment involves determining the type of angina if it is stable, unstable, variant or microvascular angina and its causes.

The doctor can perform cardiac procedures like surgery to open blocked arteries. Medicines can be administered as well. These include:

• Blood clot-dissolving drugs: These drugs are usually administered to someone with a heart attack. They help in dissolving clots and normalising blood flow to the heart muscle.
• Blood thinners help prevent clot formation in the arteries supplying blood to the heart or lungs.
• Aspirin can be used to reduce pain. ⁽²¹⁾
• Artery relaxers such as nitroglycerine can help relax the artery and make blood easily pass through the vessels.

Chest pain can be managed by addressing medical conditions that increase your risk of having it. These include taking medicines for treating diabetes and high blood pressure. ^(22,23) Adopting a healthy lifestyle such as a healthy diet and regular body exercise can help reduce your risk of experiencing chest pain.

• Antacid medications help reduce GORD episodes, which can cause chest pain.
• Antidepressants help reduce pain in patients with chest pain due to depression or panic attacks. Psychological therapy can help as well.

Pleurisy can be managed by taking non-steroidal anti-inflammatory drugs (NSAIDs), which also help to ease the pain. ⁽²⁴⁾

Depending on the severity of pleurisy, an effusion might need to be carried out. Pleural effusion is a procedure carried out in the hospital, and it involves inserting a needle or tube through the chest wall to drain out the water in the inflamed tissue of the pleura.

It is very good to take a comfortable posture while sleeping as it helps reduce pain.

Summary

Chest pain can be mild or severe and can be eased by resting or taking painkillers. However, it is better to consult your health provider if you constantly experience chest pain as it may indicate a severe medical problem that needs to be treated as early as possible.