Decoding chest pain

Decoding chest pain

Posted: Tuesday, January 17, 2012 10:07 am
By: Jack Baltz, NP, Special to The Press

Chest pain can be frightening. When it happens, it’s natural to assume that something is wrong with your heart, but chest pain can signal a variety of other conditions ranging from digestive disorders to respiratory issues. Unfortunately, it can be hard to distinguish the source of chest pain and determine if you should head to the ER, wait to see if symptoms subside, or take an antacid.

The fail proof reaction if you experience chest pain? Don’t ignore it: the first order of business is to see a doctor promptly to rule out heart trouble. Chest pain is the most common symptom of a heart attack or heart disease, and involves a feeling of uncomfortable pressure, squeezing, fullness or pain. Learn the signs and symptoms of a heart attack (see sidebar), and when in doubt, always have it checked out.

Once heart trouble has been ruled out as a possibility for your pain, several other conditions that mimic the pain of heart trouble need to be considered. These conditions typically involve the digestive, respiratory or musculoskeletal systems – and while they may not be a health emergency, most require prompt medical treatment to relieve symptoms and effectively manage the condition to minimize its effects on your overall health.


Chest pain related to a digestive disorder can include:
• Gastroesophageal reflux disease (GERD) – also known as acid reflux or heartburn, is caused when stomach acid washes back up from the stomach into the esophagus. It can cause intense chest pain felt just below the breastbone – especially at night. A recent study of ER patients at Brigham and Women’s Hospital in Boston who complained of serious chest pain revealed GERD in 57 percent of patients.
• Esophageal spasm – is a disorder of the esophagus and involves abnormal muscle contractions in the tube that carries food to the stomach. These muscle spasms make swallowing difficult and painful, and can cause chest pain.
• Hiatal hernia – occurs when part of the stomach pushes up through the diaphragm into the chest cavity, allowing food and acid to back up and cause heartburn and chest pain.
Chest pain linked to respiratory problems might include:
• Pulmonary embolism – or a blood clot in the lung – which can cause deep chest pain and is accompanied by shortness of breath.
• Pleurisy – the inflammation of the lining around the lung, which can cause sharp chest pain that worsens when you take a deep breath or cough.
Other chest pain can be linked to musculoskeletal disorders, such as:
• Sore muscles/muscle strain – also known as chest wall pain. It is often felt by athletes who begin a new or different exercise regime or increase the amount of exercise.
• Injured ribs/pinched nerves – a broken or cracked rib or pinched nerve can cause chest pain, especially when you cough or breathe deeply.
• Shingles – this skin and nerve condition caused by the reactivation of the chickenpox virus can cause sharp pain extending from the chest to the back. Burning chest or rib pain can signal the onset of shingles, and occur just before the rash develops.
Even if you suspect your chest pain is not heart-related, check with a doctor before attempting self-treatment at home.

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Two Types of Pain:

Chest pain generally falls into two categories: acute and chronic. Acute chest pain comes on suddenly and is characterized by sharp, stabbing or severe pain, while chronic chest pain develops over time, lasts longer (weeks to months), and takes longer to treat.

Acute chest pain is most often associated with a medical emergency or a condition that requires prompt medical treatment: a heart attack, hernia, rib fracture or lung condition. If you are experiencing shortness of breath, difficulty swallowing or your symptoms are not relieved by rest, call 911 or proceed to the nearest ER.

Chronic chest pain is associated with conditions such as asthma, an ulcer, GERD, a hernia, gallbladder disease, or a lung condition ranging from bronchitis to emphysema to tuberculosis. Chest pain related to these conditions can be accompanied by many other symptoms such as fever and chills; cough; wheezing; a burning sensation in the chest; or increased pain after eating, exercise or emotional stress.

A non-emergency, chronic heart condition known as stable angina involves recurring chest pain caused by an insufficient supply of oxygen to the heart muscle. This pain typically increases with intense activity, emotional stress, or extreme hot or cold temperatures; then goes away. However, angina can also be a symptom of coronary artery disease.

About the Author:  Jack Baltz is a certified nurse practitioner.  He has a master’s degree in nursing from Vanderbilt University and his nurse practitioner from the University of Tennessee in Memphis.  Jack specializes in acute care of illnesses and injuries.  He also manages the care of patients with chronic illnesses.
Remember that this information is not intended to replace the advice of your doctor, but rather to increase awareness and help equip patients with information and facilitate conversations with your physician that will benefit your health.

WCP 1.17.12

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