When chest pains are severe
That dull burning sensation in your chest doesn’t seem to go away, and you even feel like it’s getting worse. Is it a heart attack, or something else?
This is a troubling issue that millions of people and doctors face every year.
What is the problem when chest pain occurs?
Chest pain can result from dozens of conditions in addition to a heart attack, from pancreatitis to pneumonia or panic attacks. Unlike a sore knee or a sore lower back, chest pain is not something you would leave to wait until tomorrow. Also, chest pain is not a condition for diagnosis online or at home.
For that reason, we have established a CHEST PAIN CENTER in order to provide adequate help with fast and efficient diagnostics in case of cardiovascular problems or to diagnose other conditions.
Take action and work with us to find a pattern of chest pain and alleviate it. If the cause was indigestion, panic attack or some other possible recurring condition, our cardiologists can help you interpret what your body is telling you. If these are conditions that can damage your heart, then we are here to provide you with adequate treatments.
The fast lane system that we took over from the Dutch partners allows us to quickly diagnose and react to conditions:
Different causes of chest pain
Cardiac ischemic chest pain
It is most likely an acute coronary syndrome (ACS consisting of unstable angina, acute myocardial infarction with and without ST elevation) or in a less variable and dramatic form and with stable angina.
Chest pain is usually behind the sternum, patients show with the whole hand and not with one finger, it spreads to both shoulders. One study found that those with pain spreading to the right shoulder were more likely to have an acute heart attack than those with pain spreading to the left shoulder. In women with acute myocardial infarction, the pain spread more often to the neck, jaw and between the shoulder blades than in men.
Cardiac nonischemic chest pain
Inflammation of the heart sac (pericarditis), myocarditis, mitral valve prolapse, pulmonary hypertension or cardiomyopathy.
The character of pleural pain changes with the respiratory cycle and changes in body position. Carefully taken anamnesis, detailed physical examination and ECG, echocardiogram and laboratory analyzes facilitate the differential diagnosis.
Heart skipping (extrasystoles), more often ventricular, is often felt as a short chest pain.
Chest pain – aortic dissection
Chest pain in this case is characterized by sudden sharp, tearing pain, usually spreading to the back or abdomen, but towards the dissection route.
If the ascending aorta is affected, the pain can spread in the neck, and if the confluence of the coronary artery, more often the right one, is affected by dissection, there can be pain from dissection and pain of cardiac ischemic origin. About one-fifth of patients with dissection may have syncope (short-term loss of consciousness). The pain in acute myocardial infarction usually begins more gradually, and is dull in character.
Chest pain of pulmonary origin
Chest pain of pulmonary origin is the most dangerous if it occurs due to a pulmonary embolism, and is usually accompanied by difficulty breathing.
In pneumothorax, chest pain is usually sudden, sharp, usually after coughing, followed by dyspnea.
The character of pleural pain changes with the respiratory cycle and changes in body position. The patient usually lies on the side where the pain occurs, to immobilize that hemitorax, but it is not uncommon for patients to claim that they cannot lie on the side that hurts them. Pleurodynia is a pain of pleural origin, of unclear etiology.
Musculoskeletal chest pain
Patients with this pain usually have a previous history of similar pain – often cervical spondylosis. The pain is of the cutaneous type, it can be localized, it is sensitive to touch, it is alleviated by massage. It occurs as part of a Herpes zoster infection. Costochondral changes can also be a cause of chest pain.
Esophageal disorders (motility, inflammation of the esophageal mucosa – esophagitis), inflammation of the gastric mucosa – gastritis, gastric and duodenal ulcers, hiatus hernia with reflux esophagitis can sometimes give pain in the upper abdomen that spreads throughout the chest.
Pains of this type can also occur in myocardial infarction of the lower wall, so the differential diagnosis is very important.
Sometimes, pain from the gallbladder, liver or pancreas can mimic chest pain. This is especially important because in some patients there are changes in the T wave at the time of chest pain, which can be even more misleading in terms of cardiac ischemic etiology.
Psychiatric disorders that cause chest pain
Chest pain in psychiatric disorders usually occurs in episodes of panic attacks, but can also occur in depressive or anxiety states. There is usually a positive history of psychiatric illness.
Heart attack or something else?
Millions of people with chest pains are admitted to hospitals every year. 20% of them are diagnosed with a heart attack or an episode of unstable angina, a warning sign that a heart attack may happen soon.
A few have another potentially life-threatening problem, such as pulmonary embolism (blood clot in the lungs) or aortic dissection (narrowing in the inner layer of the aorta).
Many patients have angina, which occurs when part of the heart does not receive as much oxygen-rich blood as it needs during periods of physical exertion or emotional stress.
The unfortunate problem with heart attacks is that people experience them in different ways. Some have classic chest pain. Others have pain in the jaw or back. Others are left breathless, either extremely tired or nauseous.
Chest pain and heart attack symptoms
- Uncomfortable pressure, tightness, fullness, burning, tightness or pain in the center of the chest
- Pain, numbness, tingling or other unpleasant sensations in one or both arms, back, neck, jaw or abdomen
- Shortness of breath
- Sudden nausea or vomiting
- Unusual fatigue
- Heat or cold sweat
- Sudden heaviness, weakness or pain in one or both hands
Chest pain symptoms and what they mean
It’s more likely to be a heart attack
Heart attack is less common
|Feeling of pain or pressure, tightness or burning||Sharp or pain as a knife stab caused by breathing or coughing|
|Gradual onset of pain over several minutes||Sudden stabbing pain lasting only a few seconds|
|Pain in the diffuse area, including constant pain in the middle of the chest||Pain clearly on one or the other side of the body|
|Pain that extends to the left arm, neck, jaw or back||Pain that is localized in one small place|
|Pain or pressure accompanied by other signs, such as difficulty breathing, cold sweat or sudden nausea||Pain that lasts for hours or days without any other symptoms|
|Pain or pressure that occurs during or after physical exertion or emotional stress (heart attack) or at rest (unstable angina)||Pain reproduced by pressure on the chest or body movements|
Pain during a heart attack
Pain as a result of a heart attack is not limited to the area around the heart
When chest pain is a dangerous
Chest pain requires a serious approach. If you think that the cause of chest pain may be a heart attack, take measures immediately. The sooner you report, the sooner you will receive artery-opening therapies that can protect your heart from permanent damage.
Don’t play doctor – visit him quickly if you are worried about pain or discomfort in your chest, upper back, left arm or jaw.
Call 194 for emergencies due to dizziness or cold sweats, nausea or vomiting. It will take you to the hospital in a vehicle full of equipment that can keep you stable if your heart is really in big trouble.
Several centers of excellence have been established within the Pulse Cardiology Center. You can get more information about our Centers by clicking on the links: