When you feel a pain in the chest , especially if it is sudden and acute, it is easy to get scared by immediately thinking that that unpleasant sensation is to be connected to a heart attack .
But this fear is always justified.The
answer is obviously no: both because chest pain is one of the most widespread and complained symptoms and, very often the causes do not endanger the patient’s life, and because it is not only located in the chest. the heart , but also the lungs, pleurae, muscles, bones (ribs and sternum ) and above all the esophagus, the latter involved in one of the most common disorders: esophageal reflux disease.
That said, chest pain shouldn’t be underestimated either, as a late diagnosis can put the patient’s life at risk.
When to seek immediate medical attention
The symptoms that could indicate a heart attack , ischemia or an urgency profile are: a sense of oppression or constriction that accompanies the left arm and often also a sense of retrosternal weight . This type of pain can manifest itself as acute or last for more than 30 minutes.
In these cases, timely intervention is important, therefore it is recommended to consult a doctor without hesitation and wasting precious time.
We turn the page to analyze what are themost frequent causes of chest pain in both the right and left sides .
What are the causes of chest pain Without a doubt,
among the possible causes of chest pain we also find pathologies affecting the heart and certainly the causes that are excluded in the diagnosis phase, because objectively they are among the most dangerous. However, we said earlier that the reasons that can cause chest pain are of multiple etiologies.
So let’s go on to analyze them in detail.
- Cardiac disorders : the most frequent form is cardiac ischaemia (heart attack) , a situation in which the blood supply to the heart tissue decreases. In statistical terms, dissection of the aorta, pericarditis (inflammation of the pericardium, the membrane that covers the heart) and pulmonary hypertension follow. In the case of these pathologies, chest pain involves the left side (seat of the heart) and can also cause pain in the sternum ;
- Pulmonary diseases : among these the most frequent are pneumonia, pneumothorax (condition in which there is accumulation of air in the pleural cavity such as not to allow the correct expansion of the lung during breathing), pleurisy (inflammation of the pleura, membranes that cover the lungs) and tumors. If you have pain when you breathe , most likely there is a cause of pulmonary origin (especially if accompanied by cough ) which must be ascertained with the help of a specialist doctor;
- Gastrointestinal disorders : this group includes the largest number of disorders that cause chest pain such as gastroesophageal reflux, peptic ulcers, inflammation of the esophagus (or its rupture) and hiatal hernia. Pathologies of the esophagus are often accompanied by episodes of heartburn and generally by digestive disorders. The patient will then notice if certain foods make the situation worse, such as chocolate, tomato and coffee;
- Pathologies of the bones and muscles : these are disorders that affect the bone structures (ribs, sternum and vertebrae) and the numerous muscles located in the chest, these cause intercostal pain and costochondritis (inflammation of the cartilage of the ribs). Fractures are obviously also to be remembered among the possible causes of chest pain that also radiates to the back ;
- Skin disorders: Shingles and a reactivation of the chickenpox virus ( Herpes zoster ), causes severe pain in the chest, especially in the left side . The appearance of the typical skin blisters occurs after a few days, therefore given the location it is easy to think it is a pain in the heart;
- Pathologies of an extra-thoracic nature : in these cases the subject feels pain in the chest , but in reality this is nothing more than a pain caused by organs located in another anatomical site that cause painful irradiation in the chest. Frequent situation in cases of pancreatic diseases and biliary colic.
I am certainly not to underestimate the state of anxiety and fear that one feels during the episode of pain, because in itself an anxious person will tend to amplify the symptoms, and therefore anxiety and panic attacks become another. possible cause of the pain itself.
How to diagnose chest pain
The presence of chest pain can have a slight clinical significance, which can be solved with a few tricks, but in some cases it can be the alarm bell for much more serious pathologies.
It is for this reason that he is wary of improvising or relying on do-it-yourself diagnoses based on news read on the internet that certainly cannot evaluate every single case but only provide a general overview of what may be the possible causes. of the disorder. In case of acute and sudden pains, it is always advisable to consult a doctor promptly and urgently: in the event of an injury, every second can be precious.
Having clarified this point, we are going to illustrate the diagnostic procedure that is followed to reach a certain diagnosis of the disorder that causes chest pain .
Normally the phases leading to a diagnosis include an anamnesis, a physical examination and instrumental examinations that allow to confirm or exclude a diagnostic suspicion.
The doctor goes to investigate in depth the manifestations and symptoms felt by the patient, paying particular attention to the following aspects:
- mode of onset;
- site of pain ( left, right or middle side );
- duration of pain;
- precipitating factors;
- medications or positions that improve pain.
Let’s go to see these aspects in more detail.
Pain is divided into acute and chronic and again in somatic when it is of a musculoskeletal, neuropathic and visceral nature. Visceral pain, often identifies a heart attack , is not precisely localized by the patient, but involves an extended area, while somatic and neuropathic pain are defined more precisely by the patient and manual pressure on the referenced site increases the pain.
The feeling of pain in the chestit can manifest itself in different ways depending on the disorder. In the case of cardiac ischemia (heart attack) and dissection of the aorta, the pain is called migrating as it tends to move, while in the case of pleurisy, pneumonia and pericarditis the pain is perceived as a sting, or a twinge that tends to increase later coughing and breathing .
When the pain is due to diseases of the esophagus, the patient also suffers from digestive disorders: difficulty digesting, reflux, heartburn. If the disease affects the pancreas, the pain radiates from the abdomen to the chest and increases after meals. Finally, if to cause chest painthey are musculoskeletal pathologies the pain increases with the palpation and pressure of the doctor’s hands during the visit. When the patient is in a state of anxiety , on the other hand, agitation and hyperventilation (fast and labored breathing) is noted.
Symptoms related to or added to chest pain are then analyzed , such as painful swallowing (dysphagia), regurgitation of food, vomiting, nausea or a feeling of acidity.
These symptoms, if present, lead to strongly suspect that chest pain may be caused by pathologies of the gastrointestinal system, helping the doctor to exclude other clinical significance.
The precipitating factors are symptoms due to transient situations of physical stress, which once resolved bring the subject back to a state of well-being. They are therefore non-pathological conditions but which can give episodes of localized pain in the chest : exposure to cold, excessive or prolonged physical exertion, fatigue or even the fact of having eaten a large meal, a condition that leads to less blood flow to the chest.
Once all the clues necessary to suspect a disorder rather than a pathology have been collected, the doctor prescribes more detailed and specific tests for each case. To ascertain the state of health of the heart, a blood sample is taken, an examination is made on troponin, a factor that indicates whether the patient has a heart attack in progress, the patient can then be subjected to an electrocardiogram or an echocardiogram to evaluate its activity .
As for instrumental diagnostics, a CT scan or a chest X-ray allow to have a clearer vision of the pathological picture in the case of lung or bone pathologies.
What to do in these cases
What therapies we have available
Given the possibility of seriously compromising our state of health, if not our life, it is recommended to consult your doctor promptly when the perceived pain is acute, persistent and widespread.
It is not necessary to be frightened or anxious, but at the same time one should not underestimate a symptom that can indicate a serious pathology. If the clinical picture requires it, therapy is of a pharmacological and surgical nature (both linked to the single cause of the pathology).
If the pain is well localized and if the pain increases on palpation or pressure, it is likely that there is a traumatic disorder at the base. In this case, the treating doctor will be able to give you the most appropriate therapy, which will probably be based on painkillers and rest for a few days.
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