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What is Chest Pain? - Know It's Causes, Symptoms & Treatment


A guide to Chest pain and its Causes

Not all chest pains lead to heart attacks, although this tends to be the association that most people make. Chest pains need not necessarily be caused by cardiac diseases; they can originate from diseases within other parts of the body, e.g. the thorax (chest cavity), lungs, pleura, mediastinum, oesophagus, diaphragm, skin, muscles, cervicodorsal spine, costochondral junction, breasts, sensory nerves, spinal cord, stomach, duodenum, pancreas and gall bladder.

As such, a physician needs to obtain the patient’s proper history when diagnosing a chest pain. This includes details pertaining to its location, spread (radiation), character, aggravating and relieving factors, time, duration and frequency, recurrence pattern, setting and associated symptoms.

A patient’s gestures can also provide crucial information. The act of clenching the fist in front of the chest when describing the pain felt strongly suggests a cardiac origin of pain.


Typical Cardiac Pain

Patients usually describe the chest pain of cardiac ischemia and an impending heart attack as ‘pressing’, ‘squeezing’, ‘strangling’, ‘constrictive’, ‘bursting’, ‘burning’, as a ‘band across chest’, or a ‘weight in the center of chest’.

The pain normally spreads from the middle of the chest to the shoulders, then to the arms, neck, jaws and teeth. This can be caused by rising emotion, exerting effort, a heavy meal or stress. The pain usually subsides when the patient rests; pain that lasts longer than 20 minutes suggest a significant ischemia leading to a heart attack. Keeping a Nitroglycerine tablet under the tongue helps relieve the pain.

Other cardiac pains are described as 'Anginal equivalents': shortness of breath, discomfort localized to left arm, lower jaw, or teeth, neck belching, indigestion, sweating or dizziness.


Other causes of chest pain include:

  • Pulmonary Hypertension (PAH): this involves high pressures in the pulmonary arteries reaching the lungs. The pain is akin to angina pains, but is more focused in the chest, has no precipitating factors, and cannot be relieved by Nitroglycerine.
  • Pericarditis: the inflammation of the tissue surrounding the heart is usually caused by a viral respiratory infection. The pain is sharper, and is located towards the left side of the chest or the neck. It can persist for hours, and is aggravated by breathing, twisting the body and swallowing.
  • Aortic Dissection: this often occurs in patients with a history of high blood pressure. It occurs when the wall of the major blood vessel arising from left ventricle splits, typically causing pain that radiates to the back.
  • Aortic Aneurysm: the dilatation of aorta causes the erosion of the spine, leading to a localized, boring pain, which can get worse at night.
  • Oesophageal Pain: spasms or inflammation of the oesophagus (food pipe) can lead to a pain behind the chest bone and upper abdominal (epigastric) discomfort during swallowing. The patient can also suffer from an acid reflex with hiatus hernia (herniation of stomach into the chest). The pain may be relieved with antacids. Typical symptoms include a difficulty in swallowing and acid brash (acid reflux in mouth).
  • Peptic Ulcer Disease: the pain can resemble cardiac pain, but is often associated with food ingestion and is usually relieved by antacids.
  • Acute Pancreatitis: while the pain is similar to cardiac pain, it is usually triggered by alcohol consumption (or) biliary tract disease. It is usually located in the upper abdomen, radiating to the back and occasionally relieved by leaning forward.
  • Cervical Disc Disease: this involves a superficial, dull, aching pain that lasts for a variable duration and is triggered by moving the head and neck. It can be relieved by analgesics and rest.
  • Chest Wall Pain: costochondritis or myositis is common in patients who fear heart disease.

It is accompanied by local muscle or costochondral tenderness, and is aggravated by moving or coughing. It can be caused by Herpez zoster (chest wall injury) or the inflammation of costochondral joints.

  • Chest pain accompanied by coughing blood (Hemoptysis): this suggests a lung tumour or a pulmonary embolism.
  • Chest pin by fever: This suggests pleurisy, pneumonia or pericarditis.
  • Psychogenic Chest Pain: this is often caused by anxiety, and involves a localized, dull, persistent ache typically associated with emotionality. It can be accompanied by palpitation, hyperventilation, numbness and tingling of extremities, sighing, weakness, panic attack. The pain may not be relieved by medication, but can be alleviated via rest, tranquilizers and placebos.


When chest pains occur, the best course of action it to seek immediate medical help, and be clear and cooperative when detailing the symptoms to the doctor. While not all chest pain relate to heart problems, it is best to never ignore chest pains and seek medical assistance whenever it occurs.


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Ms. Oshamisu, Nigeria

Ms. Oshamisu from Nigeria came to Apollo Hospitals for treatment of fibroids in her uterus.