Chest pain: causes and diagnostic methods
What is chest pain?
Chest pain, also known colloquially as chest stabbing, can be of many types, ranging from sharp to dull. Certain pains are described as a crushing or burning sensation. In some cases, the pain is felt in the neck and jaw and then radiates backward or downward to one or both arms.
In terms of the area where it is felt, chest pain can be anterior (commonly called chest pain) or posterior (back chest pain).
Many health problems can cause chest pain, the most dangerous of which involve the heart or lungs. Since it can be difficult to determine the exact cause, immediate medical consultation is recommended.
Heart-related chest pain
Although chest pain is usually attributed to heart disease, many people with heart conditions say they experience vague discomfort. In general, chest discomfort related to a heart attack or other heart-related problem may be associated with:
Pressure or tightness in the chest
A crushing or burning sensation that radiates to the back, neck, jaw, shoulders, or arms, especially the left arm
Pain that lasts more than a few minutes, intensifies when active, comes and goes, or varies in intensity
Shortness of breath
Cold sweat
Dizziness or weakness
Nausea or vomiting
Back pain in the chest
Thoracic back pain, or pain in the thoracic spine, occurs in the area of the spine located at the back of the chest, especially between the shoulder blades.
When back chest pain occurs, it is often due to prolonged fasting or injury, which causes the muscles or joints around this area to become painful.
Prolonged postures of any kind can cause back chest pain. People who sit in a chair for long periods of time (more than seven hours a day) or those who are less active (less than 150 minutes a week) tend to have more stiffness and pain in the thoracic spine.
In addition, trauma to the thoracic spine can cause chest pain that may take several weeks or months to resolve. Movement and physical activity are very important to allow the body to heal.
Signs and symptoms of back pain in the chest
If you suffer from chest pain, these are the warning signs that you should see a doctor:
Recent serious injuries, such as a car accident or a fall from a height.
Minor injuries from heavy lifting in people with osteoporosis.
Age younger than 20 or older than 50 when the pain first appears.
A history of cancer, drug abuse, HIV infection, a condition that suppresses the immune system (immunosuppression), and long-term steroid use (about six months or more).
Deterioration in overall health, such as high fever, chills, and unexplained weight loss.
A recent infection with a germ (bacterial infection).
Permanent, intense, and increasingly severe pain.
Pain that was not caused by a sprain or strain (non-mechanical).
Pain that does not improve after 2-4 weeks of treatment.
Pain that is accompanied by severe stiffness in the morning.
Changes in the shape of the spine, including the appearance of bumps or protrusions.
Pins and needles, numbness, or weakness in the legs, which is severe or worsens over time.
Urinary or fecal incontinence (may indicate pressure on the spinal cord).
Causes of chest back pain
The most common cause of thoracic back pain is inflammation of the muscles or soft tissues of the thoracic spine. This inflammation can occur for several reasons:
A sudden sprain or strain (e.g., in the case of car accidents or sports injuries).
Maintaining a bent position for too long
Wearing a backpack that is too heavy
Spending too much time in front of the computer.
Underdeveloped back muscles due to a sedentary lifestyle
Persistent repetition of a movement involving the thoracic side of the spine (overuse injury)
Less common causes of back pain in the chest include the following:
Osteoporotic fracture
Spinal infection
Spinal osteoarthritis
Disc prolapse or herniation
Shingles (especially in people over 60)
Scheuermann's disease
Ankylosing spondylitis
Narrowing of part of the spine (thoracic stenosis)
Vertebral fractures
Spinal tumors
Other types of chest pain
It can be difficult to differentiate between pain due to a heart problem and other types of chest pain. However, chest pain that is less likely to be due to a heart condition is most often associated with the following symptoms:
Sour taste or feeling of food coming back up into the mouth
Difficulty swallowing
Pain that intensifies or improves when you change body position
Pain that intensifies when breathing or coughing
Sensitivity when pressing on the chest
The classic symptoms of heartburn, a painful, burning sensation behind the breastbone, can be caused by problems with the heart or stomach.
Causes of chest pain
Chest pain can have several causes, and all of them require medical attention.
1. Heart-related causes
Heart attack. This occurs when a blood clot blocks blood flow to the heart muscle.
Angina pectoris. Thick plaques may gradually form on the inner walls of the arteries that carry blood to the heart. These plaques narrow the arteries and restrict blood supply to the heart, especially during exercise.
Aortic dissection. This potentially life-threatening condition affects the main artery that starts at the heart: the aorta. If the inner layers of this blood vessel separate, blood is forced to circulate between the layers and can cause the aorta to rupture.
Pericarditis. This condition, inflammation of the lining surrounding the heart, usually causes sharp pain that intensifies when breathing or lying down.
2. Digestive tract
Chest pain can be caused by disorders of the digestive system, including:
Heartburn. This painful, burning sensation behind the breastbone occurs when stomach acid flows from the stomach into the esophagus, the tube connecting the pharynx to the stomach.
Difficulty swallowing. Esophageal disorders can make swallowing difficult and even painful.
Problems with the gallbladder or pancreas. Gallstones or inflammation of the gallbladder or pancreas can cause abdominal pain that radiates to the chest.
3. Muscle or bone-related causes
Some types of chest pain may be associated with certain injuries or problems affecting the structures that make up the chest wall, such as:
Costochondritis. In this condition, the cartilage of the rib cage, especially the cartilage that connects the ribs to the breastbone, becomes inflamed and painful.
Muscle inflammation. Chronic pain syndromes, such as fibromyalgia, can cause persistent chest pain related to the muscles.
Rib pain. A cracked or torn rib can cause chest pain.
4. Lung-related causes
Many lung conditions can cause chest pain, including:
Pulmonary embolism. This cause of chest pain occurs when a blood clot gets stuck in the lung in a pulmonary artery, blocking blood flow to the lung tissue.
Pleurisy. If the membrane covering the lung becomes inflamed, it can cause chest pain that intensifies when you inhale or cough.
Collapsed lung. Chest pain associated with a collapsed lung usually begins suddenly and can last for hours. A collapsed lung occurs when air builds up in the space between the lung and the ribs.
Pulmonary hypertension. High blood pressure in the arteries that carry blood to the lungs (pulmonary hypertension) can also cause chest pain.
Other possible causes of chest pain
Panic attack. If you experience periods of intense fear accompanied by chest pain, rapid heartbeat, rapid breathing, profuse sweating, shortness of breath, nausea, dizziness, and fear of death, you may be having a panic attack.
Shingles. Caused by the reactivation of the chickenpox virus, shingles can cause pain and a rash that spreads from the back to the chest.
How do we correctly diagnose chest pain?
Chest pain does not always indicate a heart attack, but this is the first thing emergency room doctors evaluate, as it can be life-threatening.
Potentially fatal lung conditions, such as lung collapse or a blood clot in the lung, can also be checked.
Among the first medical investigations recommended to diagnose chest pain are:
Electrocardiogram (ECG). This test records the electrical activity of the heart through electrodes attached to the skin. Because the affected heart muscle does not conduct electrical impulses normally, the electrocardiogram can show whether a heart attack has occurred or is occurring. This test can be performed both in the office (standard electrocardiogram) and on an outpatient basis (Holter electrocardiogram monitoring).
Blood tests. Your doctor may order blood tests to check for increased levels of certain enzymes normally found in the heart muscle. Damage to heart cells after a heart attack can cause these enzymes to enter the bloodstream within a few hours.
Chest X-ray. Chest X-rays allow doctors to check the condition of the lungs, as well as the size and shape of the heart and major blood vessels. An X-ray can also show various lung conditions, such as pneumonia or collapsed lungs.
Computed tomography (chest CT scan). Computed tomography can be used to detect a blood clot in the lung (pulmonary embolism) or to check the aorta so that the possibility of aortic dissection can be ruled out. Different CT scans can be used to check the arteries of the heart for signs of calcium, which indicate areas where plaque-caused blockages are building up. CT scans can also be done with a contrast agent to check the arteries of the heart and lungs, identify blockages, or other problems.
Echocardiogram or cardiac Doppler ultrasound. An echocardiogram uses ultrasound to produce a video image of the heart in motion. In some cases, a small device is inserted into the esophagus to get a better image of different parts of the heart (transesophageal ultrasound).
Stress test. Also known as ergometry, it measures how the heart and blood vessels respond to exertion, which can indicate whether the pain is related to the heart. There are several types of stress tests. You may be asked to walk on a treadmill or pedal a stationary bike while connected to an electrocardiogram. You may also be given an intravenous medication to stimulate your heart in a manner similar to physical exertion.
Angiography (coronary catheterization). This test helps doctors identify individual arteries leading to the heart that may be narrowed or blocked. Contrast dye is injected into the arteries of the heart through a catheter: a long, thin tube is inserted through an artery, either at the wrist or in the groin, and threaded up to the arteries of the heart. As the contrast dye fills the arteries, they become visible through X-ray and video exposure.