What Causes Chest Pain?

Chest pain, which can range from a dull, tight sensation to a sharp, stabbing pain, may sometimes radiate to the arm and neck. The causes of chest pain can be symptoms of various diseases. In serious problems related to the heart and lungs, the exact cause of chest pain should be determined, and immediate medical intervention is required

What Are the Symptoms of Chest Pain?

Chest pain can be divided into two categories: heart-related and other causes. Heart-related chest pain has typical characteristics and occurs in situations that require emergency intervention.

Heart-related Chest Pain:
In this type of chest pain, patients experience discomfort in the chest. The pain can feel like pressure, burning, or tightness in the chest. It may radiate to the jaw, arm, shoulders, and back. Heart-related chest pain lasts longer than a few minutes and may fluctuate in intensity. The pain intensifies with movement or activity and diminishes with rest. Chest pain may be accompanied by shortness of breath, cold sweats, fatigue, exhaustion, nausea, and vomiting. This typical chest pain associated with the heart is called angina.

Chest Pain Due to Other Causes:
It may not always be possible to differentiate between chest pain caused by the heart and other causes. However, symptoms such as a sour taste in the mouth, the feeling of food coming back up into the mouth, difficulty swallowing, changes in pain intensity depending on body position, pain worsened by coughing or deep breathing, long-lasting pain, and pinpoint pain typically indicate problems other than heart-related issues.

What Causes Chest Pain?

There are many different problems that can cause chest pain. Chest pain caused by different factors has distinct characteristic features.

Heart-related Causes:

• Heart Attack: Occurs due to the complete blockage of the coronary arteries that supply blood to the heart. Blood flow to the heart stops, and the heart becomes deprived of oxygen and nourishment. As a result, the cells in the heart muscle cannot function and die. Early intervention in a heart attack aims to prevent the death of heart muscle cells. After the heart stops, tissues like the brain, which are quickly affected by a lack of oxygen, may be damaged. It is critical to immediately recognize patients suspected of having a heart attack and provide emergency care.
• Angina: This occurs due to significant narrowing or temporary blockage of the coronary arteries and their branches that supply the heart. As the diameter of the blocked vessel decreases, blood flow through it is reduced. Particularly during exercise, the increased oxygen demand of the heart cannot be met due to reduced blood flow, leading to pain. If treatments to prevent further blockage or procedures like angioplasty to open the blocked or narrowed artery are not performed, angina may progress to a heart attack.
• Aortic Dissection (Tear): Aortic dissection, which involves the tearing of the aorta, the main artery that carries blood from the heart to the body, is a life-threatening condition. It occurs when the layers of the artery wall separate, allowing blood to flow into the separated layers and causing a tear. This condition leads to a stabbing pain in the chest and back.
• Pericarditis: Inflammation (infection) of the pericardium, the membrane surrounding the heart, leads to sharp chest pain that worsens with breathing or lying down.

Chest Pain Due to Digestive System Disorders:

• Heartburn, GERD (Gastroesophageal Reflux Disease): A burning sensation felt behind the breastbone. This occurs when the acidic contents of the stomach flow back into the esophagus. Consuming foods such as coffee, carbonated drinks, and acidic foods can worsen the burning sensation caused by reflux.
• Swallowing Disorders: Swallowing difficulties, usually related to esophageal problems, cause discomfort and pain when swallowing.
• Gallbladder and Pancreatic Disorders: Inflammation in the gallbladder or pancreas can lead to abdominal pain that radiates to the chest.

Musculoskeletal Causes of Chest Pain:

• Costochondritis: Inflammation of the cartilage in the chest wall, often causing localized chest pain.
• Painful Muscles: Conditions like fibromyalgia, which causes chronic and widespread pain, can lead to persistent pain in the chest muscles.
• Rib Injuries: Chest pain may occur in cases of rib fractures, cracks, or contusions.

Chest Pain Due to Lung Conditions:

• Pulmonary Embolism: Blood clots that form in the veins can travel to the lungs and block the arteries supplying blood to the lungs, stopping blood circulation in the lungs. This condition can cause chest pain.
• Pleurisy: Inflammation of the lining around the lungs can lead to chest pain, which worsens with breathing or coughing, similar to pericarditis.
• Pneumothorax (Collapsed Lung): Occurs when air leaks into the space between the lung and the rib cage, leading to sudden chest pain, often accompanied by shortness of breath.
• Pulmonary Hypertension: Increased blood pressure in the blood vessels that supply the lungs can cause chest pain as one of its symptoms.

Other Causes of Chest Pain:

• Panic Attack: Chest pain associated with rapid heart rate, excessive sweating, and nausea may indicate a panic attack.
• Shingles: A viral infection caused by the same virus that causes chickenpox. In cases where the immune system is weakened, the virus can reactivate and lead to painful blisters on the face, back, and hips, accompanied by fever, headache, and nausea.

How is Chest Pain Diagnosed and Treated?

If chest pain suddenly occurs and resembles a heart attack, the patient should immediately seek emergency care at the nearest health center. It is highly likely that heart-related chest pain is caused by a life-threatening problem that requires urgent intervention. The answers to the doctor's questions about the onset, type, intensity, and duration of the pain are crucial in determining the cause of the chest pain.

Diagnostic methods such as an EKG (electrocardiogram) that shows the heart's electrical activity, blood tests, chest X-rays, echocardiogram (an imaging method that assesses heart function), MRI of the heart and aorta structures, stress tests to evaluate heart function during exercise, and angiograms that reveal blocked arteries can be used to determine the cause of chest pain.

The treatment of chest pain varies depending on the underlying condition. In cases caused by blocked coronary arteries, medications may be used to open the blocked arteries, such as clot-busting drugs and anticoagulants to prevent further clotting. In more severe cases, the artery identified during angiography may be treated with a stent placement, which relieves the blockage. If multiple arteries are affected, surgical intervention (bypass) using other arteries in the body may be considered.

In cases where chest pain is caused by non-cardiac factors, such as reflux, antacid medications and stomach protectants may be used.

Chest pain caused by a panic attack can be treated with anti-anxiety medications.

Chest pain may indicate a serious condition. Individuals experiencing chest pain should definitely seek medical attention at the nearest health center for evaluation. Identifying the cause of chest pain and providing appropriate treatment not only prevents the recurrence of chest pain but also prevents more serious health issues from arising. It is important to remember that conditions like older age, diabetes, hypertension, and high cholesterol increase the risk of heart attacks. Those with one or more of these risk factors should seek immediate emergency care if they experience chest pain.