Chest Pain: When to Worry

by | Nov. 01, 2011


The following are some guidelines we use in helping us determine which body system is most likely the cause of your chest pain and how to best treat you. However, please remember, if you have undiagnosed chest pain, go and get it checked out!

Cardiovascular: Heart disease is listed as the most common cause of death in the United States. As doctors we usually start here and work our way down. Much can be determined by a simple review of the patient’s cardiac risks. These include age, gender (men are more commonly affected than women), heredity, smoking, high blood pressure, high cholesterol, diabetes, obesity, physical inactivity, emotional stress, and behavior.

While you have no control over the first three, much can be done to modify the others. If you have several risk factors, I recommend you talk to your primary care doctor, start where you are, and take measures now to improve your risks. Irregularities in the speed or force at which your heart is beating also warrant further evaluation.

Pulmonary: Lung problems may present as chest pain. Shortness of breath and an associated fever could indicate pneumonia or other infections. Tightness and wheezing can be from asthma or an allergic reaction. A recent surgery or swollen leg associated with chest pain may represent a blood clot to the lungs (pulmonary embolism). A sudden shortness of breath or an injury may represent air leaking out into the chest cavity and cause a lung to collapse (pneumothorax). Smoking increases a number of conditions including COPD (chronic obstructive pulmonary disease) and cancer.

If the physician hears fluid in the lungs, this may also represent an infection or trouble with the heart, kidneys, liver, or even an undiagnosed cancer. A simple chest x-ray can help to determine many of these. Pleurisy is when the sack lining the lungs or when the inside of the chest wall becomes inflamed and painful with deep breaths.

Gastrointestinal: The heart essentially sits on top of the stomach and the esophagus tube is directly behind the heart. These are common causes of chest pain. Peptic ulcers, acid refluxing up into the esophagus, or even a hiatal hernia are all common causes of pain and are difficult to differentiate from heart-caused pain. The esophagus muscle is tricky, as it can spasm, cause pain, and be relieved by nitroglycerin just as cardiac pain can. That’s why we run further tests to make sure. Gall bladder and pancreatic pain can also sometimes mimic chest pain and often bore through to the back.

Musculoskeletal: Muscle strains, broken ribs, or inflammation where the ribs and cartilage join (costochondritis) are common causes of chest pain. Deep breaths and twisting or turning movement and direct pressure over the chest that cause an increase in pain all help us determine if this is the cause.

Neurologic: A bulging or herniated disc in the spine can pinch a nerve and cause pain wherever that nerve goes. This is usually one sided rather than bilateral.
Dermatologic: Shingles is a condition in which a dormant chicken pox virus travels along a nerve from the spine and can cause chest pain on one side of the body. The deep burning ache is usually followed by groups of clustered blisters on a red base. Anyone can get this, but the risks of shingles pain increases with age. There is now a vaccine available to those over 60 years of age to help prevent this.

Psychiatric: This is more common than you might think. Stresses at work, school, and home are common sources of anxiety and panic attacks and can cause irregular heartbeats and chest pain. The sensation of chest pain is the body’s physical response to a complex interplay of chemical, electrical, hormonal, vascular, neurologic, and emotional factors. We can’t always “choose” how we physically respond to stress. But we can choose what to do about it.

Adherence to several basic principles of both physical and spiritual health can help us avoid many of the ailments that plague our society, including chest pain. Simply focusing on proper nutrition, regular exercise, and a good night’s rest is a great place to start. But if you do have chest pain and have any question as to the cause, please see a doctor ASAP to have this thoroughly evaluated.

Now, let’s get healthy!

-Dr. Boud

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