Chest Pain- Patient Perspective

Experiencing a pain in the chest is one of the most alarming feelings one can have. When this occurs for the first time, one automatically fears the worst. Everyone has seen or heard of some of their near and dear ones encountering chest pains, which were later diagnosed by a doctor as a symptom of what we commonly refer to as a ‘heart attack’. 

What causes chest pain? 

Apart from aches and pains caused by an external injury to the chest, here are some of the possible causes ¹ of chest pain:  

• Diseases of the food-pipe: including conditions in which the pain is described as ‘heartburn’ or ‘acidity’. 
• Diseases of the heart: including stable and unstable angina, a blockage in the blood supply of the heart, inflammation of the covering of the heart. 
• Diseases of the blood vessels connected to the heart. 
• Diseases of the lungs: like pneumonia and lung cancer. 
• Inflammation of the skin and/or breast. 
• Breast pain associated with the menstrual cycle in women. 
• Conditions affecting the bones, muscles and nerves of the chest. 
• Diseases of the digestive system, nervous system, abdomen, and spine.
• Certain psychiatric conditions. 

As we can see, there are various possible causes for chest pain. While some of them are relatively benign, others like angina can be life-threatening and require emergency treatment, and regular medication to prevent their re occurrence. Hence, it is critical that an individual who experiences chest pain should seek medical attention, to determine what caused it. Any episode of chest pain experienced in the past should also be brought to medical attention, since it can reveal the presence of hidden disease. 

It is important to remember that one cannot differentiate heart-related chest pain from other causes, by himself or herself. Angina is caused by a blockage in the blood vessels supplying the heart, and only a doctor can detect and diagnose it. ² Neglecting such a blockage can be disastrous, and even fatal. Hence, neglecting chest pain by dismissing it as ‘just acidity’ is a bad idea, and can prove fatal. 

Chest pain as an emergency

Chest pain is one of the most common symptoms among patients needing emergency care. A significant fraction of such patients are ultimately diagnosed with an acute heart condition. Of those who are diagnosed with the latter, one section will be found to have had a ‘heart attack’. The long-term risk of heart disease is much higher in patients with acute chest pain than in those who do not experience it. 

Differentiating the causes of chest pain 

As we have seen, chest pain can have many underlying causes. Patients and their attendants can help a doctor arrive at a specific diagnosis by noting and recalling the specific details of the pain experienced. Some of these details, which can help a doctor differentiate one cause from another, are: ^{1 2}

• Beginning of the pain: Was it sudden, or has it been felt for a long time? In case it is chronic, is it felt all the time, or on and off? If so, when and how frequently does it recur? 
• Location of the pain: Is it felt all over the chest, or is it most intense in a particular area of the chest?  
• What sensation does the pain cause? Is it heaviness, burning, squeezing, discomfort or something else? 
• Does the pain spread to other parts of the body, like the shoulder, arm, jaw, back etc? 
• Aggravating factors: Do activities like coughing, swallowing, deep breathing, straining, exercising or moving in a particular manner make the pain worse? 
• Relieving factors: Does changing the position of one’s body, or taking previously prescribed medicines reduce the pain? 
• Duration of pain: Does it last for seconds, minutes or hours? 
• Other symptoms: Is the pain accompanied by a noticeably stronger and/or rapid heartbeat, increased sweating, breathlessness, coughing up blood, giddiness, nausea?     
• Does the patient have previously diagnosed diseases like high blood pressure, diabetes, lung conditions etc? 

Why is it important to communicate these details to a doctor? 

In emergency rooms as well as in scheduled consultations, accurately communicating such details, as well as correctly answering any questions the doctor may have, can help both the doctor and the patient in many ways: 

• In the emergency room, it can assist a doctor in deciding whether the cause of chest pain is a real emergency and needs immediate attention or not. 
• In all settings, it helps a doctor rule out unlikely causes of chest pain and choose the correct set of diagnostic tests to determine the exact cause, thus avoiding unnecessary tests. 
• Early recognition of symptoms by a patient can help achieve an early diagnosis, preventing the worsening of the disease with medical intervention, and preventing future complications of the disease. 
• An accurate reporting of symptoms can also help prevent overtreatment, which is unnecessary, and merely adds to the time and resources spent by a patient in a medical setting. 

Reference key: 

1: Golwalla’s Medicine for Students, section on Chest Pain.  

2: Harrison’s Principles of Internal Medicine, Volume 1, Chapter 12: Chest Discomfort