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Chest pain can be a frightening symptom, and it can be challenging to determine its exact cause. While cardiac conditions are a common cause of chest pain, musculoskeletal chest pain, originating from the muscles, bones, or joints of the chest wall, is another possibility. This type of pain can be due to various conditions, including muscle spasms, which can have different underlying causes and require specific treatments. One example of muscle spasms leading to chest pain is diaphragm spasms, involuntary contractions between the chest and abdomen that can cause discomfort but are typically not serious. Another critical condition is coronary artery spasm, a sudden narrowing of the arteries supplying blood to the heart, which can result in chest pain and, in some cases, lead to a heart attack.
| Characteristics | Values |
|---|---|
| Musculoskeletal chest pain | Comes from the muscles, bones, joints, tendons, or ligaments in your chest wall |
| Pleurodynia | Inflammation of chest muscles due to viral infection, causing episodes of sharp spasms followed by lingering ache |
| Tumors | Malignant neoplasm (cancerous tumor) spreading from lungs or breasts into the chest wall |
| Coronary artery spasm | Brief tightening of blood vessels supplying blood to the heart, causing chest pain or tightness |
| Diaphragm spasm | Sudden involuntary contraction of the diaphragm muscle between the abdomen and chest, causing pain and tightness |
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What You'll Learn
Coronary artery spasm
Angina, or angina pectoris, is temporary chest pain or a sensation of pressure that occurs when the heart’s need for oxygen is not satisfied by the amount of blood supplied to the heart. Blood flow can be limited when the arteries are narrowed by atherosclerosis or because of coronary artery spasms. Angina due to atherosclerosis usually occurs during physical exertion or emotional distress, or at rest if the artery is narrowed by more than 70%. While artery blockage from cholesterol plaque is a more common cause of angina, coronary spasms can also result in chest pain called vasospastic angina. Unlike angina from plaque, vasospastic angina can often happen while you are resting. Coronary artery spasms can also lead to an irregular heart rhythm in the heart’s lower chambers (ventricular arrhythmia). If the spasm lasts long enough, it may even cause a heart attack.
The main symptom of coronary artery spasm is chest pain, but it can also be "silent", without any noticeable symptoms. If you do experience symptoms, you might feel light chest pain, especially pain that occurs during rest, often after midnight or in the early morning hours, or on the left side of your chest. Coronary artery spasms vary in length. They may last anywhere from five to 30 minutes. The spasms may cause chest tightness, or pain extending from the chest to the neck, arms, or jaw. Symptoms of angina may also include discomfort in the shoulders, inside the arms, through the back, and in the throat, jaw, or teeth.
The goal of treatment is to prevent spasms and relieve chest pain. If you have a spasm, a medicine called nitroglycerin (Nitrostat) widens your arteries to improve blood flow and relieve chest pain. To prevent spasms long-term, your provider may prescribe medications such as calcium channel blockers, which relax your arteries, or statins, which lower your cholesterol and may prevent spasms.
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Musculoskeletal chest pain
Other causes of musculoskeletal chest pain include:
- Costochondritis
- Rib fractures, either traumatic or stress fractures
- Slipping rib syndrome, which occurs in children with chronic chest and abdominal pain
- Pectoralis muscle injury
- Myofascial pain and fibromyalgia
- Sternalis syndrome, which involves abnormal sternalis muscles that grow from your major chest muscles and cover your sternum
- Xiphoid syndrome (xiphoidalgia or xiphodynia), a rare condition causing pain in the tip of the sternum
- Pleurodynia (Bornholm disease), an inflammation of chest muscles due to a viral infection
- Tumors, such as a malignant neoplasm that spreads from the lungs or breasts into the chest wall
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Pleurodynia (Bornholm disease)
Pleurodynia, also known as Bornholm disease, is an acute, transient viral myositis involving the intercostal and abdominal muscles. It is characterised by inflammation of the chest muscles due to a viral infection. The illness usually lasts 3-5 days and causes fever and sharp, spasmodic pain in the chest wall or abdomen. It is often preceded by a moderate to severe headache, nausea, vomiting, and pharyngitis.
The most common cause of Bornholm disease is the Coxsackie B virus, which is spread primarily through the faecal-oral route. It can also be transmitted through respiratory secretions and oral-oral methods. Local outbreaks with high infection rates within affected households have occurred, and major epidemics can take place every 10 to 20 years. The illness typically lasts longer in adults than in children, but patients usually make a full recovery with supportive care.
Bornholm disease is a clinical diagnosis that uses the spasmodic pain, fever, and relapses to distinguish the illness from other potential causes of pain such as appendicitis or myocardial infarction. It can be diagnosed through physical examination, electrocardiogram (ECG), and viral studies.
Other names for Bornholm disease include Bamble disease, devil's grip, devil's grippe, epidemic myalgia, and Sylvest-Bing disease.
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Sternalis syndrome
The treatment for sternalis syndrome aims to relieve pain and improve functional outcomes. Conservative measures such as nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and targeted exercises may be used to manage symptoms. Local interventions, including injections of local anesthetics and corticosteroids into the sternomanubrial joint or surrounding structures, can provide temporary pain relief. In cases of refractory pain, Botox injections have been shown to be effective by temporarily paralyzing the hyperactive sternalis muscles. However, the optimal treatment approach for sternalis syndrome is yet to be established, and individualized plans tailored to the patient's specific symptoms and response to interventions are crucial.
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Diaphragm spasms
Musculoskeletal chest pain can be caused by muscles, bones, or joints in the chest wall. While cardiac chest pain is considered "typical", musculoskeletal chest pain has distinct qualities. It can be caused by conditions such as sternalis syndrome, xiphoid syndrome, pleurodynia, or tumours.
The phrenic nerve controls the movement of the diaphragm, and irritation or inflammation of this nerve can trigger spasms. Hiatal hernias, which occur when part of the stomach moves up into the chest through an opening in the diaphragm, can also trigger diaphragm spasms. In most cases, diaphragm spasms will subside within a few minutes and may not require medical attention. However, frequent spasms without an apparent cause should be evaluated by a doctor to rule out any underlying medical conditions.
While diaphragm spasms usually resolve on their own, it is important to focus on maintaining regular breathing patterns during an episode. Resting the diaphragm by using a manual resuscitator or non-invasive ventilatory support has been successful in treating diaphragmatic flutter in some cases. In addition, breathing exercises can help strengthen the diaphragm and keep it functioning properly.
In summary, diaphragm spasms can cause chest pain and discomfort, but they typically do not pose a serious health risk. However, frequent or persistent spasms may indicate an underlying medical condition and should be evaluated by a healthcare professional. Treatment options vary depending on the underlying cause.
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Frequently asked questions
A muscle spasm is an involuntary and often painful contraction of a muscle.
Yes, muscle spasms in the chest wall, diaphragm, and coronary arteries can all cause chest pain.
Coronary artery spasms are sudden tightenings of the blood vessels that deliver blood and oxygen to the heart muscle. They can cause chest pain and increase the risk of a heart attack.
