Chest pain: what does it tell us, when to worry?

By Cristiano Antonino On Apr 18, 2023

Chest pain is a very common condition and can be a symptom of a number of more or less serious diseases

Depending on the cause, chest pain can be dull, burning or sharp.

Many patients describe it as similar to a stab wound, others to strong pressure.

Diseases that can cause this disorder include lung disease, heart disease, digestive diseases, rib fractures, Tietze’s syndrome, shingles infections, pectoral or intercostal muscle injuries.

Treatment varies depending on the causes and symptoms.

Chest pain: what is it?

Chest pain is a symptom of several diseases.

The pain can affect a rather large area from the base of the neck to the upper abdomen.

Depending on the cause, chest pain may be dull, sharp, burning, stab-like, oppressive (feeling as if something is compressing the chest).

It may be concentrated to the left, right or centre, depending on the causative factors.

Chest pain: causes

Causes of chest pain include heart disease, lung disease and diseases affecting the oesophagus and stomach.

This disorder is also linked to episodes of pancreatitis, rib fractures, pectoral and intercostal muscle injuries, biliary tract and gallbladder diseases, Tietze’s syndrome and costochondritis.

In some cases, chest pain may be caused by herpes zoster infections or mastitis episodes.

Finally, psychological causes such as panic attacks and anxiety should not be excluded.

Chest pain: diagnosis

The diagnosis aims to identify the cause of the disorder.

First, the doctor carries out a careful anamnesis and an objective test.

Depending on the results, an echocardiogram, electrocardiogram (ECG), coronarography or myocardial scintigraphy can be performed.

Other useful tests are chest X-ray (chest X-ray), nuclear magnetic resonance imaging (MRI), CT scan of the chest, endoscopy and blood tests.

Recognising the cause of chest pain is crucial for appropriate treatment.

Chest pain: treatment

The treatment of chest pain is directly related to its causes and varies according to them.

If the disorder is caused by heart disease, pleurisy, gastro-oesophageal reflux disease, pulmonary embolism, pulmonary hypertension, pancreatitis, hiatal hernia, costochondritis or Tietze’s syndrome, pharmacological treatment is prescribed and a radical change in lifestyle is recommended.

In the case of severe heart disease, advanced pulmonary hypertension, hiatal hernia and severe pulmonary embolism, surgery is required.

If the disease causing the chest pain is bacterial in origin, the treatment will consist of administering antibiotics.

When the condition is, on the other hand, a symptom of a rib fracture or pectoral muscle injury, the only possible treatment is rest accompanied by pain-relieving medication.

Chest pain and heart disease

Chest pain may be associated with heart disease.

The main ones include myocardial infarction, myocarditis, pericarditis, angina pectoris, cardiomyopathies and valvulopathies.

Myocardial infarction, commonly known as a heart attack, involves the necrosis of a part of the heart muscle tissue (the myocardium).

This causes an interruption of blood flow in a coronary artery (coronary artery disease).

This condition is often caused by atherosclerosis and thrombo-embolic phenomena, more rarely by drug use.

Those affected require immediate medical attention or they may suffer fatal consequences.

In patients with myocardial infarction, chest pain is radiating and also affects the arms, shoulders and often the jaw, and is accompanied by other symptoms such as sweating, vomiting, dizziness, weakness, nausea and dyspnoea.

Coronary artery disease involves an interruption of blood flow in the coronary arteries due to atherosclerosis, while angina pectoris indicates cardiac distress caused by reduced oxygenated blood flow in the coronary arteries.

Less serious than myocardial infarction, this condition presents similar symptoms such as chest pain, sweating, fatigue and nausea.

Myocarditis is an inflammation of the heart muscle, called the myocardium.

It is caused by viral or bacterial infections, autoimmune diseases, alcohol abuse or exposure to heavy metals.

In addition to chest pain, the patient experiences palpitations, difficulty breathing, and fever.

Pericarditis is related to inflammation of the pericardium, the membrane that surrounds and protects the heart.

It can occur in cases of pneumonia, autoimmune diseases, viral, parasitic or bacterial infections.

This condition causes intense and constant chest pain that also spreads to the shoulder muscles and neck.

The symptoms are even more acute when lying on one’s back, during swallowing and when taking deep breaths.

Cardiomyopathies are diseases that cause an anatomical alteration of the myocardium, leading to malfunctioning of the heart.

There are different types of cardiomyopathies: dilated, hypertrophic or restrictive are the most common.

This pathology can also be hereditary or acquired and, in addition to chest pain, leads to cardiac arrhythmias, dyspnoea, syncope, fatigue and oedema in the lower limbs.

Finally, valvulopathies are diseases that affect the heart valves that are responsible for regulating the transit of blood through the heart.

The disease can be congenital in nature or occur later in life when a heart valve acquires an altered shape or does not function properly.

Chest pain and lung diseases

Chest pain can be caused by certain lung diseases such as pleurisy, pulmonary embolism, pneumonia, pneumothorax, pulmonary hypertension and asthma.

Pleurisy is an inflammation of the pleura, the thin membrane that surrounds and protects the lungs.

The chest pain associated with pleurisy is usually acute and worsens when taking deep breaths or coughing.

In addition to this symptom, dyspnoea, coughing and fever are also experienced.

Pneumonia, on the other hand, is caused by an inflammation of the lungs and can be viral, bacterial or fungal.

Usually the chest pain is dull, deep and continuous, accompanied by fever, coughing, chills and wheezing during breathing.

Pulmonary embolism is caused by the obstruction of an artery in the pulmonary circulation due to the presence of an embolus, i.e. a blood clot that usually starts in the lower limbs.

Chest pain in this case is followed by acceleration of the heartbeat, breathing problems, cyanosis, dyspnoea and coughing.

Pneumothorax, on the other hand, is the abnormal infiltration of air into the pleural cavities, with the collapse of the lungs.

It is most often the consequence of chest trauma with pain that worsens during deep breaths.

Pulmonary hypertension is a disease caused by elevated blood pressure in the pulmonary arteries and right heart cavities.

The condition causes chest pain, syncope, tachycardia, fatigue, ascites, cyanosis, palpitation and oedema in the lower limbs.

Finally, asthma is a chronic condition that affects the bronchi and bronchioles, causing breathing problems.

Symptoms occur after exposure to allergens and drugs or following strong emotions or physical exertion.

Chest pain is associated with dyspnoea, choking and coughing.

Chest pain and gastroesophageal diseases

Chest pain may be a symptom of a gastro-oesophageal disease such as peptic ulcer, hiatal hernia or gastro-oesophageal reflux.

The latter disorder is characterised by acid contained in the stomach rising into the oesophagus.

It involves inflammation of the inner wall of the oesophagus and can lead, if left untreated, to more serious diseases such as oesophageal ulcer, oesophageal stricture or Barrett’s oesophagus.

In this case, the chest pain is burning and radiates to behind the shoulder blades, followed by laryngitis, dysphagia and pharyngitis.

A peptic ulcer, on the other hand, is a lesion of the mucous membrane of the digestive system.

It can form in the stomach (gastric ulcer), in the duodenum (duodenal ulcer) or in the lower part of the oesophagus (oesophageal ulcer).

The most common cause is a Helicobacter pylori infection.

Chest pain is accompanied by digestive difficulties, vomiting and nausea.

A hiatal hernia is a protrusion of the stomach through the oesophageal diaphragmatic hiatus, i.e. the hole in the diaphragm through which the oesophagus normally passes on its passage from the chest to the abdomen.

The causes are still unclear, while symptoms include, in addition to burning chest pain, aerophagia, bitter mouth and frequent belching.

Chest pain may be associated with pancreatitis, i.e. an inflammation of the pancreas.

This condition is characterised by violent and sudden pain radiating towards the back, followed by vomiting, fever and shock.

Finally, this condition can be a symptom of gallbladder and biliary tract problems (gallstones).

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