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Let’s talk about chest pain

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By Dr. Kaycee Reyes

How we treat our bodies is a two-way street: when we take care of our bodies, our bodies take care of us too. A lot of times, however, we take our health for granted until our bodies suffer. This is why when we experience sickness, discomfort, and pain, worry overcomes us. Chest pain, for example, can say a lot of things about our body, from non-critical causes such as asthma, acid reflux, and nerve pain, to life-threatening ones such as acute coronary syndrome, aortic dissection, or pulmonary embolism, among others. And the truth is, because the chest area contains a lot of organs, it is a challenge among physicians to pinpoint the exact cause of chest pain including “matters of the heart.”

Thoracic organs are those located between the neck and the diaphragm that contains structures of the cardiovascular system, respiratory system, digestive system, nervous system, endocrine, and lymphatics that share nerve pathways. Because of these intertwined organs, the root cause of symptoms is harder to specify, even with detailed patients’ descriptions or a review of their medical history. Because of a wide range of causes for chest pain, it also accounts for a lot of Emergency Room (ER) visits. Non-threatening causes of chest pain may be:

  • heart-related such as valvular heart disease or pericarditis (inflammation of the sac surrounding the heart);
  • lung-related such as respiratory infections (pneumonia, bronchitis);
  • gastrointestinal such as gastroesophageal reflux (or GERD caused by frequent acid reflux), esophageal spasm (irregular contractions on the esophagus), or pancreatitis (inflammation of the pancreas);
  • musculoskeletal such as fractures or muscle strains;
  • psychiatric such as those who have panic attacks; among others

ER physicians concentrate on the possible life-threatening symptoms, if any, because sometimes, those that pose a threat do not show any signs at all. The general approach is to make a detailed analysis of the patient’s history of chest pain such as describing its onset, triggers, quality of pain, location of pain, timing, recent surgeries, tests or operations, other symptoms such as nausea or vomiting, and other factors such as lifestyle. Asking about prior tests and studies are needed as well. Knowing if the pain is similar to the current one may also help with the diagnosis. Among the more serious illnesses, Acute Coronary Syndrome (ACS caused by an immediate reduction of blood flow to the heart) is one of the most fatal diseases among adults in developed countries. The patient’s discomfort may vary from tightness, heaviness, pressure, or squeezing. The pain may come from the left chest, and may radiate on other parts such as the arm, neck, jaw, back, shoulders, or abdomen. It may also be accompanied by other symptoms such as sweating, vomiting, and nausea, but it is not always the case. There are other more random symptoms, however, especially among the elderly, women, or those who are diabetic that must be noted as well. Older patients may also complain about difficulty breathing, weakness, loss in consciousness, or changes in mental state. Risk factors for ACS include cocaine and methamphetamine use. Another serious illness that presents chest pain is Aortic Dissection (when the inner layer of the heart’s aorta or blood vessel tears or splits) that is reported to kill three per 100,000 individuals per year. This number may even be higher as some patients pass away even before diagnosis. The pain presents as a sharp, tearing feeling, often felt at the chest but may begin at the back. Loss in consciousness or change in mental state may also occur; however, it may present different associated symptoms depending on the arteries involved. The patient may also present to have pulmonary embolism, pneumothorax (air in between the lungs and chest wall that may cause the lung to collapse), or pericarditis (inflammation of the tissue that surrounds the heart).  Those who are pregnant or individuals below 40 years old with Marfan syndrome (genetic disorder of the connective tissue) are at risk for this condition. Pulmonary embolism (blockage of an artery in the lung) is another life-threatening disease where diagnosis is often missed earlier and incidence may be higher than reported. Unfortunately, it can bring about various types of pain and can be associated with different symptoms as well such as cough or loss of consciousness. Risk factors for pulmonary embolism include long distance travel, a previous orthopedic procedure, pregnancy, use of oral contraceptives that may raise levels of estrogen or progestin, and family history, among others.

As you can see, chest pain is more than just “matters of the heart.” Clinicians must be careful and thorough in assessing each individual as chest pain may vary from asthma to a life-threatening one such as ACS. Remember, it is our responsibility to know our body well. Do not panic with every discomfort that you feel; however, do not disregard it altogether as well. Observe your body and see a physician immediately if the pain does not go away or becomes unbearable. Also, do not self-medicate. Lastly, love your body by giving it the exercise, nourishment, and rest it needs. You only have one body: use it well, and love it well.

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