The Spectrum Of Chest Pain

Chest pain is a common symptom that can arise from various causes. Chest pain may manifest as a sharp, stabbing pain, a dull ache, or a constant burning sensation that comes and goes. Many medical conditions can manifest with chest pain originating from musculoskeletal, cardiac, gastrointestinal (GI), pulmonary, and anxiety-related causes, some of which are chronic. While chest pain can be alarming, the symptoms do not always signify a need to go to the hospital. However, there are certain situations where seeking medical attention is critically important. Early diagnosis and treatment of the underlying cause can significantly improve health outcomes, and differentiating these causes from chronic pain can make a difference.

Insidious chest pain causes

Infections can sometimes cause chest pain. Pneumonia, a lung infection, can trigger a sharp or stabbing sensation that worsens upon coughing or deep breathing. The pain may be exacerbated by lying flat. Pleurisy, an inflammation of the lung lining, can also cause sharp chest pain worsened by movement or breathing. In some cases, infections around the heart can cause pericarditis, which results from inflammation of the sac around the heart. Often, pericarditis is accompanied by sharp chest pain that intensifies with exertion. Each of these disease states will demonstrate a combination of fever and chills, body aches, and malaise resulting from the immune response to infection.

Don’t ignore these signs

Ischemia occurs when oxygen is prevented from getting to the target tissue. Heart attacks occur suddenly when an artery develops a blockage and presents with severe pain and pressure, sweating, and shortness of breath (SOB). The sudden onset and associated symptoms are the hallmarks of identifying an urgent need for medical attention. Rapid evaluation preserves heart muscle and function, and minimally invasive procedures are lifesaving. Sudden sharp chest pain, SOB, and rapid heart rate can also occur from a pulmonary embolism when a blood clot circulates to the lungs. Emergent diagnosis warrants rapid evaluation by a healthcare provider to initiate blood thinning medications and interventions.

A hidden threat

Aortic dissection is another serious medical emergency that occurs when the intimal or inner layer of the aorta, the main artery of the body, develops a tear. This tear permits blood to flow between layers of the aortic wall, causing severe pain that radiates from the chest to the back or neck. The pain is often described as ripping and associated with SOB, sweating, rapid heart rate, weak pulses, and altered mental status. Risk factors include uncontrolled hypertension (HTN), connective tissue disorders, age >60, and smoking. Immediate medical evaluation and consultation by a cardiothoracic surgeon are critical for a successful outcome.

Chest pain key takeaways

Chest pain is a common symptom with a wide range of causes, from chronic musculoskeletal disorders to anxiety. Identifying variations from more serious causes can make a difference, especially when lifesaving interventions are indicated. The key lies in understanding the spectrum of causes of chest pain and recognizing the warning signs that require immediate medical attention. Early diagnosis can significantly improve health outcomes and mortality rates when these conditions present with red flags like sudden chest squeezing, ripping, and tearing pain associated with other symptoms of SOB, rapid heart rate, and altered mental status.