Doc’s Corner

When to Worry About Chest Pain
Chest pain can signal serious heart or lung problems.

Sometimes chest pain is just chest pain. Sometimes it’s only a muscle strain, heartburn or bronchitis. More often than not there are benign reasons. You should however, be evaluated by a physician if you’re worried.
Still, chest pain can signal a serious condition, heart-related or otherwise. Here’s when you should call a healthcare provider if you’re having chest pain.
Heart trouble
When people hear the term “chest pain,” one of the first conditions that springs to mind is a heart attack, and with good reason; chest pain is the most common symptom of a heart attack in both men and women. It usually feels like pressure and can often radiate to the arm, neck or jaw. It’s not the only sign though, and women especially are prone to experiencing other symptoms, like fatigue, nausea, indigestion and shortness of breath. But pain from a heart attack can radiate throughout the upper body. including the neck, jaw, shoulders, either or both arms, stomach or back. In a 2014 study of 736 people in the Journal of the American Heart Association, researchers found that women were twice as likely as men to report pain in the arm or shoulder during an acute coronary syndrome event, of which heart attack is one (unstable angina is the other). According to another study published in Gender Medicine, women were much more likely than men to report being nauseated during a heart attack. More than half of the women in the study experienced nausea, compared to less than a third of the men. If you’re winded like you’ve just run a marathon but you haven’t gotten off the couch, take note. Shortness of breath, or dyspnea is a common symptom of heart attack in women. Shortness of breath may or may not be accompanied by chest pain. Nausea (and vomiting) are symptoms of many conditions, so it’s important to be aware of other symptoms of a heart attack, especially chest pain, if you’re nauseated or throwing up.

Chest pain can also signal other heart trouble. To a cardiologist, ‘angina’ is a word to describe chest pain related to the heart. Angina is frequently caused by coronary heart disease, where plaque builds up in the arteries and slows down blood flow. In women it can be seen with large vessel narrowing or with microvascular disease. “Angina” feels differently to different people. The most classic diagnosis is chest pressure, a heaviness that happens with exertion and goes away with rest.
Another heart-related reason for chest discomfort could be certain types of heart failure. No, that doesn’t mean your heart stops beating—that’s cardiac arrest—but it does mean your heart cannot deliver enough oxygen-rich blood to meet the body’s needs. The most common symptoms include shortness of breath, coughing or wheezing, fluid backup—especially in the lungs or legs—and fatigue, but chest pain is a possible symptom too.
Lung problems
What else is in your chest besides your heart? That’s right, the lungs—and one of the most serious causes of chest pain is a pulmonary embolism, a potentially suddenly fatal event. That’s when a blood clot lodges itself in and blocks blood flow to the lungs. Pulmonary embolisms are often a complication of deep vein thrombosis, a blood clot that starts most often in the legs. Other symptoms of pulmonary embolism include shortness of breath and other breathing problems, as well as coughing—with or without blood.
Pneumonia is a common illness, but it can be severe. It’s the number one cause of hospitalization for US adults other than giving birth. About one million American adults are hospitalized with pneumonia each year and about 50,000 die. Chest pain is often a symptom, especially when you breathe or cough. Other pneumonia symptoms include fever, chills, cough and shortness of breath.
While it’s usually a complication to a chest injury, sometimes a collapsed lung can happen spontaneously without an identifiable reason. Also known as pneumothorax, a collapsed lung occurs when air escapes from the air sac (pleura) that surrounds the lung and gets trapped between the lung and the rib cage. Pain in the chest, especially when breathing or coughing (pleurisy), is one of the most common symptoms. Others include fatigue, lightheadedness, a rapid heart rate and a bluish tint to the skin. Chronic conditions such as asthma, cystic fibrosis and chronic obstructive pulmonary disease can also increase the risk of a collapsed lung.
When to worry, when to relax
Cardiologist and physicians generally are most worried when someone complains of chest pain during exertion, as well as feeling lightheaded and possibly shortness of breath. Assuming that someone is not profoundly anemic, exertion, usually left sided or mid-sternal chest pain (angina) may indicate a significant portion of the heart was not getting enough blood flow. Another clue that would be worrying is if the chest pain is coming on with less and less activity or at rest, suggesting a coronary artery blockage that is progressing.
As for when you might not need to be concerned, chest pain can be caused by a muscle strain, costochondritis (inflammation of the cartilage around the ribs), esophageal spasms, acid reflux, or bronchitis. Tenderness of the chest wall that duplicates the pain and is present at rest and does not get worse with activity is more likely not related to the heart. Take into consideration the associated additional symptoms and how the pain presents and manifests. The setting or other known risks of the individual can provide important clues as to the significance of the chest pain symptoms. Knowing your risk factors and current state of health, can be very strategic when an acute situation presents, such as chest pain. Having a primary care physician familiar with your health status and risk factors is a valuable resource often neglected. Implementing strategic lifestyle choices and taking advantage of resources readily available in 2017 should reduce the chances of sustaining a sudden heart attack by more than 95%. Unfortunately we as a society are a long way off from making this concept a reality. However, it’s better to be safe than sorry. If you’re worried about your chest pain, see a healthcare provider or call 9-1-1.

Paul R. Block, MD, FACP, FCCP

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