Chest Pain

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What it feels like: varies from a dull ache, to tenderness, to a sharp,searing pain anywhere in the chest.

What can make it worse: swallowing, coughing, deep breathing,movement, cold weather, sexual intercourse, anxiety, eating.

What can make it better: food, antacids, nitroglycerin, rest, mas-sage of the painful area.

Your Doctor Visit

What your doctor will ask you about: heart palpitations, anxiety,depression, light-headedness, numbness or tingling in your hands oraround your mouth, fever, chills, sweating, coughing, coughing upblood or mucus, feeling short of breath, tenderness, trouble swallow-ing, nausea, vomiting, swelling or pain in the legs, changes in weight,pregnancy, smoking.

Your doctor will also want to know if you’veever had a stress test (usually an electrocardiogram [EKG] whileexercising on a treadmill), or have been treated for heart trouble withmedications or heart surgery.

Your doctor will want to know if you or anyone in your familyhas had any of these conditions: lung disease, asthma, chest surgery or injury, cardiovascular disease, high blood pressure, diabetes,elevated levels of cholesterol or fat in the blood, angina, phlebitis,emotional problems, obesity, congestive heart failure, heart attack,smoking.

Your doctor will want to know if you began feeling chest painafter chest injury or another specific event, or if the pain is fre-quently associated with eating, particular stressful events, orheavy exertion.

Your doctor will want to know if you’re taking any of these med-ications: oral contraceptives, diuretics (“water pills”), digitalis, bron-chodilators, nitroglycerin, tranquilizers, sedatives, antacids, or bloodpressure medications such as beta-blockers, calcium channel agents,and antiarrhythmics.

Your doctor will do a physical examination including the fol-lowing: temperature, weight, blood pressure, pulse, listening toyour chest with a stethoscope, listening to your heart with a stetho-scope, examining your legs for tenderness, warmth, or swelling,electrocardiogram.

Your doctor may do the following blood tests: blood count, test-ing for heart enzymes.

WHAT CAN CAUSE CHEST PAIN, AND WHAT IS TYPICAL FOR EACH CAUSE?WHAT CAN CAUSE CHEST PAIN, AND WHAT IS TYPICAL FOR EACH CAUSE?

Cause: Chest wall  ache
What is it: Pain in the chest wall
Typcal Symptoms: Tenderness in the chest wall, often worsening withmovement or deep breathing, and possibly resultingfrom injury or a bout ofviolent coughing

 

Cause: Rib fracture
What is it: A crack in one of the ribs
Typcal Symptoms: Tenderness over the fracture, often accompaniedby the sound or sensationof grating and crackling

Cause: Neck pain
What is it: Pain in the neck that  radiates to the chest
Typcal Symptoms: Chest or arm pain that worsens when moving orputting pressure on theneck

Cause: Heartburn
What is it: Also known as GERD  (GastroEsophageal Reflux Disease), the movement  of stomach acid up into  and through the  esophagus, which connects the throat to the stomach; can lead to ulcer (see below)
Typcal Symptoms:  Burning upper abdominal  pain, worse when lying flat  or bending over, particularly  soon after meals, relieved  by antacids or sitting  upright

Cause: Ulcer
What is it: Severe irritation of the  stomach or intestinal  lining
Typcal Symptoms: Burning upper abdominal  pain that is worse when  lying down, sometimesrelieved by antacids andmade worse by aspirin ordrugs such as ibuprofen

Cause: Cholecystitis
What is it: Gallstones
Typcal Symptoms: Fever, right upper abdominal pain, sometimes painin right shoulder, nausea,vomiting, chills, sometimesjaundice (skin taking on ayellowish appearance),dark urine

Cause: Arthritis/bursitis
What is it: Inflammation in or around the joints
Typcal Symptoms: Tenderness in the shoulder,  ribs, or muscles, often inthe lower chest, may resultafter prolonged coughing

Cause: Angina pectoris
What is it: Sudden spasms of chest  pain caused by lack of  oxygen to the heart  muscles
Typcal Symptoms: Chest pain behind the  breastbone, aggravated by  exertion and relieved by  rest; pain may radiate tothe left arm

Cause: Heart attack
What is it: Blockage in one of the  arteries feeding the heart, leading to death of part  of the heart muscle
Typcal Symptoms: Severe, often crushing pain  behind the breastbone,  sometimes with sweating,  nausea, or vomiting

Cause: Crescendo  angina (preinfarction angina)
What is it: A more severe form of   angina pectoris (see   above)
Typcal Symptoms: Attacks of angina (see above) that occur more frequently, or become moresevere over time

Cause: Pneumonia
What is it: An infection of the lungs
Typcal Symptoms: Fever, chills, shaking,coughing up blood ormucus, sharp chest pain

Cause: Pneumothorax
What is it: “Collapsed lung”: an  accumulation of air  between the lungs and  chest wall
Typcal Symptoms: Sudden onset of breathing  difficulties, sharp chest  pain

Cause: Pulmonary embolus
What is it: A blood clot blocking the   flow of blood to the lungs
Typcal Symptoms: Sudden onset of breathing  difficulties, dull chest pain, sweating, light-headedness,apprehension, cough,coughing up blood,swelling or tenderness inthe calves

Cause: Pleuritis
What is it: Inflammation of the outer  layer of the lungs
Typcal Symptoms: Sharp pain anywhere in  the chest, often aggravatedby deep breathing, coughing, or movement

Cause: Pericarditis
What is it: Inflammation of the sac  surrounding the heart
Typcal Symptoms: Pain over the heart or  behind the breastbone,often aggravated by deepbreathing, coughing, ormovement

Cause: Dissecting  thoracic aortic  aneurysm
What is it: A tear of the aorta, the   largest blood vessel in   the body, which comes  directly out of the heart
Typcal Symptoms: Searing chest pain that can  start between the shoulder  blades, abdominal pain

Cause: Lung tumor
What is itCancer of the lungs
Typcal Symptoms:  Changes in coughing pat-terns, coughing up blood,chest ache, more commonin smokers

Cause: Esophageal  spasm
What is it: A contraction of the   muscles in the esophagus
Typcal Symptoms: Severe pain behind the breastbone that is oftenrelieved by eating, difficulty swallowing

Cause: Esophageal  tear
What is it: A tearing of the muscles  in the esophagus
Typcal Symptoms: Sudden and severe pain  behind the lower breastbone, vomiting, sweating,often a result of a neckwound

Cause: Esophageal  stricture
What is it: A constriction of the   esophagus, which  connects the throat to  the stomach, that doesn’t let food pass
Typcal Symptoms: Chronic pain behind the  breastbone, food regurgitation, heartburn (see above)

Cause: Esophageal  cancer
What is it: Abnormal cell growth in   the esophagus
Typcal Symptoms: Feeling like food “sticks” in  the throat or causes pain,weight loss, malnutrition

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