What does chest pain indicate?

My two-cents Rx

Benj S. Bangahan, M.D., FPCP, FPCCP

Chest pain is one of the most frequently complained about symptoms by many people,  but in spite of its being common, it is nonetheless considered as the most scary, maybe for an obvious reason -– the chest cavity houses some organs that people think possess important roles in the lengthening or shortening of a person’s life. Rightly or wrongly, perhaps, for there are actually a number of possible causes of  pain that can be manifested in the chest, ranging from simple to the complicated ones, with each kind differentiated from the others by each respective characteristics, which are important to the doctors in their process of analysis anddiagnosis. It is for this purpose that patients should be exact with their descriptions when asked by their attending physicians.

Chest pain may be simply categorized as those that arise in the structures located in the chest wall, which doctors sometimes term as “lateral or chest wall pain”, those that arise in the internal organs located in the chest cavity, termed as  “visceral or central pain”,  and one that should not be overlooked,  those that  do not show any organic reason for the pain, simply called anxiety-caused  pain, which belong to the psychiatrist.

Chest wall pain is usually described as sharp, well localized to an area, and is increased by deep breathing or coughing; it is sometimes referred to as  pleuritic pain or pleurisy since it is associated with any disease that brings about inflammation of the lung covering called  pleura, such as infections like pneumonia, tuberculosis or pus formation (empyema); trauma like in pneumothorax or air accumulation in the pleural space, hemothorax or blood accumulation, or rib facture; and tumors of varied forms.  Chest wall pain may also be manifested as a sign of herpes zoster and inflammation of the rib joints.

On the other hand, the frequently mentioned internal organs where visceral or central chest pain arise in are the respiratory tree, esophagus, and probably the most feared, the heart and its structures.  Acute bronchitis, or the inflammation of the main stem of the respiratory tree, manifests with pain that is made worse by coughing. Also, cancerous growth within the bronchus and the mediastinum manifests this type of pain. The visceral pain that arises in the esophagus is usually secondary to reflux of stomach acidic content and is made frequent when the patient is lying down in bed, a process made easier by gravity. Esophageal pain is related to meals and is relieved by antacid;  it is known to cause spastic cough and can be mistaken for a lung condition.

 As has been alluded to, the pain that arises in the heart has been the most feared one since it may be due to an insufficient supply of blood through the arteries to the heart itself that are blocked. The insufficiency engenders partial damage to the heart muscle and renders it functionally inadequate, though when the damage is  minor and treatment is apt, the condition is successfully tided over.  Sometimes when the treatment is administered late or there is no proper medical regimen, the injury may worsen the clinical status,  transforming into a more damaging myocardial infarct,  and causing death.

The pain of the initial stage, the angina pectoris, is induced by exertion of effort and typically becomes relieved by rest. Usually patients describe the feeling as sensation of heaviness or tightness located right under the sternum, the solid bone in the middle  of the anterior side of the chest, or  at the left half of the anterior chest.  

Occasionally it may be radiated to the left arm or the left shoulder, to the jaw, or may even manifest like toothache.

There are other cardiovascular conditions that do manifest chest pain, though to a lesser  frequency. There is pericardial pain, which rises in the cover of the heart (pericardium), and which gets relieved by sitting up or leaning forward. There is also the deep pain of dissecting aneurysm of the aorta, not too frequent but is quite lethal.

Patients who feel something like the above described symptoms must at all cost try to find a way to get to a hospital. Or better still, one should not forget to care for his or her own self. Dr. Benj Bangahan

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