Dominic Stone
Chest pain can be a frightening experience, and it is often hard to tell where the pain is coming from. While chest pain is usually associated with heart attacks, it can also be caused by issues in the lungs, muscles, tendons, ligaments, bones, or joints in the chest wall. Cardiac chest pain is considered typical, but it is important to note that most chest pain is not related to the heart. Chest pain can be sharp or dull, and it may feel like pressure, tightness, or squeezing. It can spread to other parts of the body, such as the shoulders, arms, neck, jaw, abdomen, or back. Determining the cause of chest pain is crucial, and seeking medical attention is always recommended.
| Characteristics | Values |
|---|---|
| Typical chest pain | Pressure, squeezing, clenching |
| Location of pain | Chest, neck, jaw, arms |
| Other symptoms | Tingling, numbness, sweating, nausea, shortness of breath |
| Aggravating factors | Exercise |
| Relieving factors | Rest, nitroglycerin |
| Musculoskeletal chest pain | Sharp or stabbing muscle spasms, dull ache, fever |
| Underlying causes | Tumors, anxiety, depression, rheumatic diseases, injuries |
| Cardiac chest pain | Pressure, heaviness, tightness |
| Emergency symptoms | Lasting longer than 5 minutes, no relief with rest or medication, shortness of breath, nausea, vomiting, light-headedness, fainting |
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What You'll Learn
Musculoskeletal chest pain
There are several other causes of musculoskeletal chest pain. Costochondritis (swollen chest cartilage) is one of the most common causes. Chest wall syndrome refers to nontraumatic causes of musculoskeletal chest wall pain, which may include diagnoses such as costochondritis, atypical chest pain, and cervicothoracic angina. Fibromyalgia is a relatively common syndrome that causes musculoskeletal pains, including chest pain. Pleurodynia (Bornholm disease) is inflammation of the chest muscles due to a viral infection. Precordial catch syndrome is a mysterious but ultimately harmless condition that causes a brief, sharp, left-sided chest pain. It might be related to slouching. Sternalis syndrome involves abnormal muscles called sternalis muscles that grow from the major chest muscles and cover the sternum. They cause pain when they become hyperactive and spasm. Xiphoid process pain is a rare condition that causes pain in the tip of the sternum, which may radiate to the chest or abdomen.
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Precordial catch syndrome
PCS is a common condition, especially in older children, teenagers, and young adults. It is harmless and typically not a medical emergency. However, it can cause anxiety in those who experience it, as they may fear that the pain is a sign of a more serious heart or lung condition. PCS has been recognised since at least 1893, when it was first described and named by French cardiologist Henri Huchard.
The underlying cause of PCS is unclear, but it is believed that the pain may be related to the chest wall or irritation of an intercostal nerve. It has also been suggested that PCS may be due to pinched nerves or muscle spasms in the lining around the lungs (pleura) or in the ribs or cartilage. Some cases of PCS have been associated with poor posture or slouching, and it may also be related to a recent growth spurt.
While PCS is typically harmless, complications can arise, such as dizziness from taking short, shallow breaths due to anxiety about the pain. Treatment for PCS is usually reassurance that the pain is not serious and is not related to the heart. The pain generally resolves without specific treatment, and taking deep breaths and allowing the rib cage to fully expand can help relieve the discomfort.
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Tumours
While heart pain and chest muscle pain can be related, chest pain can also be caused by other factors, such as tumours. Tumours can cause chest pain due to their growth and spread, leading to a range of symptoms.
Types of Tumours
Chest wall tumours can develop in the bones, soft tissues, and cartilage of the chest cavity, which encompasses the heart, lungs, and other vital organs. These tumours are uncommon and challenging to treat, constituting less than 5% of thoracic malignancies. They are often invasive or metastatic in nature, with over 50% being malignant. Primary chest wall tumours can be cancerous (malignant) or non-cancerous (benign), while secondary tumours, which originate elsewhere and spread to the chest wall, are always malignant.
Primary non-cancerous chest wall tumours include various types, such as cavernous hemangioma, chondroma, desmoid tumour, and eosinophilic granuloma, each affecting different parts of the chest wall. On the other hand, chondrosarcoma, Ewing's sarcoma, and fibrosarcoma are examples of primary cancerous chest wall tumours.
Symptoms and Diagnosis
Chest wall tumours can manifest as painful, rapidly growing masses that are easily felt. However, symptoms may vary, and some tumours may not exhibit any noticeable signs until they reach an advanced stage. Possible symptoms include a palpable lump, fever, muscle atrophy, pain, tenderness, swelling, difficulty with movement, and unexplained weight loss.
Diagnosis of chest wall tumours involves a comprehensive approach, including a review of medical history, physical examination, and additional tests such as imaging scans and biopsies. Specialists in thoracic radiology and pathology play a crucial role in accurate diagnosis.
Treatment
Treatment options for chest wall tumours include surgery, chemotherapy, and radiation therapy. Surgery may involve the removal of ribs to extract the tumour, followed by reconstruction to restore the chest wall's appearance. Minimally invasive procedures, such as video-assisted thoracic surgery (VATS), are also utilised. Chemotherapy and radiation therapy are often used in conjunction with surgery to shrink or kill cancer cells and improve the chances of recovery.
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Anxiety and depression
Chest pain can be a symptom of a heart attack, and cardiac chest pain can be life-threatening. It is important to get an accurate diagnosis to rule out any life-threatening causes of chest pain.
A study of 803 people with coronary heart disease (CHD) found that chest pain predicted more severe anxiety and depression symptoms at all time points up to 30 months after the baseline. However, the association between anxiety and chest pain did not last beyond 18 months. This suggests that anxiety and depression are consequences rather than causes of cardiac chest pain.
If you are experiencing chest pain, it is important to seek medical attention to determine the underlying cause and receive appropriate treatment.
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Heart attack symptoms
Heart attacks occur when the flow of blood to the heart is severely reduced or blocked. The blockage is usually due to a buildup of fat, cholesterol, and other substances in the heart (coronary) arteries. The process of plaque buildup is called atherosclerosis. A heart attack is a serious medical condition that requires immediate medical attention. Here are some common symptoms of a heart attack:
Chest Pain or Discomfort
Chest pain or discomfort is a common symptom of a heart attack. It can feel like pressure, squeezing, fullness, or pain in the center or left side of the chest. This discomfort can last for several minutes and may go away and come back. It may also spread to other areas of the upper body, including the arms, neck, or jaw.
Shortness of Breath
Shortness of breath is another warning sign of a heart attack. This symptom often occurs along with chest discomfort, but it can also happen before or without it. Shortness of breath can be a frightening experience and should not be ignored.
Pain in Other Areas
In addition to chest pain, a heart attack may cause pain or discomfort in other areas of the body. This can include pain or discomfort in the shoulders, back, neck, jaw, or upper belly. The pain may feel sharp or dull and may spread from the chest to other areas.
Other Symptoms
Other symptoms of a heart attack can include feeling weak, light-headed, or faint. You may also experience unusual or unexplained tiredness, nausea, vomiting, or breaking into a cold sweat. Women may experience atypical symptoms, such as brief or sharp pain in the neck, arm, or back. Additionally, anxiety and depression can cause non-cardiac chest pain, which can be psychosomatic and have no apparent physical cause.
If you or someone else is experiencing any of these symptoms, it is crucial to call for emergency medical help immediately. Do not delay seeking help, as prompt treatment is necessary to prevent death and reduce damage to the heart muscle.
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Frequently asked questions
Heart-related chest pain, or cardiac chest pain, is considered "typical" chest pain. It usually feels like pressure, squeezing, or clenching, and may spread from the chest to the neck and jaw or down the arms. It may also be accompanied by sweating, nausea, or shortness of breath, and it tends to worsen with exercise and improve with rest.
Musculoskeletal chest pain may be caused by issues with the muscles, bones, or joints in the chest wall, as well as injuries and rheumatic diseases. It can cause episodes of sharp or stabbing muscle spasms followed by a lingering dull ache that worsens when taking a deep breath. Fever and sweating are also common symptoms.
Chest pain has many potential causes, including heart, lung, and digestive issues. If you are experiencing chest pain, it is important to seek medical attention to determine the underlying cause. A healthcare professional can determine whether the pain is heart-related, muscle-related, or due to another condition.
