Chest Pain – Symptoms and Causes

Chest pain can be described as piercing pain or a minor steady ache, which often makes people uncomfortable and restless. In some cases, chest pain can also give a burning or crushing sensation, which lasts for a specific period. However, the intensity of chest pain depends on the underlying medical condition. In some cases, chest pain could also be an indication of a heart attack or a heart ailment. In other situations, chest pain could be a small non-harmful issue.

But irrespective of the intensity, chest pain and more importantly, recurrent chest pain should be given immediate medical attention to. Moreover, it is critical to consult a specialist to know the underlying cause and treat the same. 

Heart-related causes of chest pain

If the chest pain is due to an underlying condition of the heart, a person will also experience additional symptoms like shortness of breath, vertigo and heart tremors. A few heart-related conditions that can cause chest pain include:

Angina: Angina is a feeling of pressure or squeezing of the heart, which leads to intense pain and dizziness. Angina is a very common heart issue and usually occurs because of the minimum supply of blood to the muscle of the heart. A person experiencing angina can often mistake it for a heart attack. However, angina is not a very condition and does not lead to any permanent damage to the heart tissue. That said, angina experienced during physical activity is not a matter of concern but angina while sitting or in a relaxing mode is a very serious issue and will need immediate attentive medical care.

Heart attack: In some cases, people experience intense chest pain that travels further to the left arm or the jaw is often due to a heart attack. A person experiencing a heart attack is likely to get a feeling of sharp chest pain, along with tightness and stabbing feeling in the heart.Chest pain caused because of a heart attack indicates that there is a blockage in one or more arteries that is eventually resulting in lack of blood supply to the heart. Moreover, a person experiencing chest pain because of heart attack can also have symptoms like shortness of breath, extreme sweating, nausea, uneven pulse, feeling of choking, extreme weakness and numbness.

Myocarditis: Myocarditis is a medical condition where the heart muscle is swollen because of multiple causes including fever. Myocarditis causes mild pain or pressure in the heart, which can often appear as chest pain. Pain in the heart is also accompanied byshortness of breath, swollen legs, palpitations, etc.Myocarditis is not a seriously alarming condition but in case, there are severe symptoms, medical attention is required.

Pericarditis: Pericarditis is another common heart issue, which is often confused with a heart attack. This condition happens when there is swelling in the watery sac covering the heart. The chest pain caused because of pericarditis can be sharp or dull. It usually begins in the centre of the heart and then radiates to the left side of the heart. A person experiencing this medical issue might also have other symptoms like fatigue, muscle ache and mild fever. The swelling or inflammation can happen because of an existing infection or even due to previous heart surgery. The symptoms of pericarditis usually fade away in a week or so but in case, the signs last longer than this period, medical help is necessary.

Valve Disease: Pain in the chest which occurs because of any exertion can indicate a potential problem in the heart valve.Some other symptoms of valve disease are murmur, breathlessness and fatigue.

Cardiomyopathy: Cardiomyopathy is a medical condition that occurs because of thickening or thinning of heart muscles. The issue in the heart muscle disturbs the normal pumping action of the heart and causes chest pain. This chest pain usually occurs post eating or exercising. Other accompanying symptoms include swollen legs and ankles, heart tremors, and uneven heart rhythm. A patient with cardiomyopathy will require medical care immediately.

Aortic Rupture: Pain in the chest accompanied by a sharp pain in the upper back could likely be a sign of aortic rupture. This aortic rupture happens because of ablood leakage due to a tear within the aortic walls of the heart.

Respiratory causes of chest pain

In other cases, chest pain could also be an indication of a potential issue with the respiratory system of the body. Some respiratory problems that can cause chest pain include:

Pneumonia: If a person experiences chest pain along with strong, stabbing pain, the kind which gets intense with each breath, is more likely because of pneumonia.Some of the other signs that occur along with the chest pain in pneumonia are fever, chills and severe cough, with phlegm. In case a patient has any of these issues or even such mild symptoms, call emergency help.

Asthma: Asthma causes swelling the airways and leads to tightness and pain in the chest of the patient. However, asthma can be easily managed provided it is diagnosed and treated in time and effectively.

Chronic Obstructive Lung Disease (COPD): COPD is a disease, which blocks the inflow and outflow of air via the lungs due to swelling or inflammation. A chest ache that worsens with the rise in physical activity or exertion could be due to COPD.

Pulmonary Embolism: Chest pain can also occur because of a pulmonary embolism, which happens when a blood clot forms in one of the arteries of the lungs. This blockage makes it difficult to breathe and can feel similar to that of a heart attack.

Collapsed Lung: In some instances, the patient might feel a tingling sensation or pain in the chest while breathing. This could indicate a collapsed lung where the air gets trapped between the walls of the chest and the lungs. Thus, in turn, pressurises the lungs and makes it problematic for the lungs to expand upon inhaling of air.

Other respiratory issues that cause chest pain could include pleurisy, lung cancer and pulmonary hypertension. That said, the chest pain in these health issues is more recurrent in nature. 

Digestive causes of chest pain

Digestive issues that cause chest pain happens because of a malfunction of the digestive system and the connected esophagus. Chest pain caused because of digestive concerns worsens at the time of lying down and improves with movement, exertion or any physical activity. Such chest pain is a likely indication of one of the below digestive problems:

  • Gastroesophageal Reflux Disease (GERD) – acid reflux ailment causing a burning sensation in the chest
  • Esophagitis – fiery sensation and chest ache while swallowing
  • Esophageal Rupture
  • Dysphagia – discomfort and pain while swallowing
  • Gallstones
  • Pancreatitis
  • Hiatal Hernia

Some other causes of chest pain

Apart from the heart, respiratory and digestive causes of chest pain, the below issues can also lead to acute pain in the chest

  • Extreme anxiety 
  • Panic attack
  • Muscle strain
  • Injured rib
  • Costochondritis, which is swelling of the rib cartilage

Diagnosis of Chest Pain

To know the actual reason for chest pain, the doctor will conduct diagnostic tests. Some of the tests useful for this purpose are:

  • An electrocardiogram (ECG or EKG) to check the electrical activity of the heart
  • A blood test to assess the enzyme level in the body
  • Chest X-ray to evaluate the condition of the heart, lungs and blood vessels
  • An Echocardiogram to obtain the moving images of the heart
  • An MRI to measure the existing damage to the aorta or the heart muscle
  • Stress test
  • An Angiogram to assess any blockage in arteries

Treatment of Chest Pain

To treat chest pain in patients, it is critical to understand the underlying cause and the intensity of the issue. The treatment of chest pain can include medications, non-invasive procedures, surgery or a combination of these.

The below methods can be used to cure heart-related chest pain: 

  • Medicines
  • Cardiac catheterization, which includes the usage of balloons or placement of stents to open the narrowed or blocked arteries of the heart
  • Coronary artery bypass grafting or bypass surgery that surgically repairs the injured or compromised arteries

The methods below can treat chest pain caused because of other issues:

  • Lung re-inflation for patients where the chest pain is because of a collapsed lung
  • Antacids or other medical procedures for patients that experience acid reflux and heartburn, along with their signs
  • Anti-anxiety medicines to treat patients that have chest pain due to panic attacks

Overall, it is advisable to not ignore chest pains or take them lightly. It is good to consult a doctor upon any troubling symptoms and eliminate any chances of a serious underlying condition. Timely help is always beneficial.

Cardiac Emergency: You Must Know a Little About It

According to research, one in four deaths in India happen because of cardiovascular diseases. In this, ischemic heart disease and stroke are accountable for more than 80% of this burden. That said, heart problems, especially emergencies like cardiac arrest or a heart attack can happen to anyone at any age. Even though the incidence of these issues is more common in elder people, but young people have also become highly prone to these ailments. Hence, it is critical to know about cardiac emergency.

Cardiac Emergency

A cardiac emergency is a condition where the patient gets a life-threatening cardiac arrest or a heart attack. Cardiac arrest is a medical state where the heart of the patient suddenly stops working, leading to loss of breath and sudden consciousness. A cardiac arrest happens when the heart, which is responsible for generating and pumping blood in the body, does not function properly. This improper functioning of the heart causes loss of blood flow in the body, particularly the brain. Further, if the situation intensifies and no medical attention is received, the patient suffering from a cardiac arrest can succumb to death. Cardiac arrests are abrupt and sudden, and also very different from a heart attack. 

In a heart attack, the blood flow to a specific part of the heart is blocked. That said, a heart attack can further lead to a cardiac arrest in some cases. A heart attack is a serious medical condition where the heart stops functioning because of lack of oxygen and nutrients for a prolonged period. The oxygen and nutrients that the heart is deprived of are very critical for its proper functioning and to ensure there is enough blood in the body. When the blood supply is restricted or blocked due to reasons like a build-up of plaque, blocked arteries, etc. the heart is starved and eventually stops working, thus, causing a heart attack.

That said, a cardiac arrest is different from a heart attack and has varied symptoms, diagnostic process, and treatment.

Symptoms of Cardiac Arrest

Below are some of thesymptoms of a cardiac arrest: 

  • Abruptly racing heartbeat
  • Life-threatening anxiety
  • Vertigo
  • Uneven heart rhythm
  • Flapping ventricles
  • Frozen body temperature and numbness 
  • Abrupt collapse
  • Pain and difficulty in breathing
  • Loss of pulse

Most of these signs happen close to a cardiac arrest, whereas other cardiac symptoms can sometimes indicate an upcoming dysfunctionality. These might include:

  • Chest ache or uneasiness
  • Shortness of breath
  • Exhaustion 
  • Weakness
  • Tremors

That said, it is always advisable to get advanced medical help to assess any irregularities in the functioning of the heart. A patient should see a doctor if he/she experiences any of these signs:

  • Chest pain or distress
  • Fast or uneven heartbeats
  • Nonstop and unexplained wheezing
  • Shortness of breath
  • Life-threatening heart palpitations
  • Loss of awareness
  • Dizziness 
  • Blurry vision

Most cardiac arrest symptoms do not last for a long time and often do not give time to take action before the actual arrest happens. Hence, the best way to save a person from a cardiac arrest is to avoid the causes and factors that might trigger the condition.

Symptoms of a Heart Attack

Signs of a heart attack differ from one person to another. In some people, the symptoms appear early-on, whereas, in others, there could not be any significant signs.

Some signs that could likely indicate a heart attack, include:

  • Severe chest pain
  • Shortness of breath
  • Heaviness or tightness in the chest
  • Intense pain in the back, jaw, left arm, right arm, shoulders or all of these areas
  • Extreme sweating
  • Vomiting
  • Nervousness
  • Dizziness
  • Racing heartbeat
  • Fluctuating blood pressure
  • Thready pulse
  • Pale and cool skin

The intensity of the heart pain and the attack varies from person-to-person. In many cases, a minor heart attack can be considered as heartburn. Such attacks are not harmful and usually pass silently. Medically, this situation is also known as angina. However, angina is a warning sign, and even if it does not cause any harm in the present, there is a high chance that a problem can occur in the future. In the case of angina, the blood flow is restored soon, and the pain also goes off quickly.

Further, in many cases, a heart attack can also happen without any prior warning or symptoms. This silent attack is known as ‘silent ischemia’. In this medical condition, the heart tissue is damaged due to sporadic, disruptions of blood flow to the heart. A person suffering from diabetes is at a high chance of facing silent ischemia. However, this condition can easily be diagnosed via an ECG. Moreover, in the case of women, heart attack symptoms are different. Women generally feel tight and full in their chest or experience pain in the neck, arm or jaw.

Steps to Survive a Cardiac Emergency

A cardiac emergency, heart attack or cardiac arrest, can be treated only with immediate action. Some effective resurrection cures include:

Cardiopulmonary Resuscitation (CPR): CPR is an emergency lifesaving method, which helps to rejuvenate a non-beating heart. CPR should be performed immediately to ensure the flow of blood and oxygen to the body is maintained, in case the heart and breathing stop because of various reasons like a cardiac arrest, heart attack, drowning, etc. Since CPR only involves chest compressions and specific breathing techniques; thus, an untrained bystander, medical professional or any other person can perform CPR to save a person. However, CPR should be done in the order of CAB – Compressions, Airway and Breathing. 

Defibrillation: Defibrillationincludes advanced care for a specific type of arrhythmia, which can also lead to a cardiac arrest. Defibrillation involves administering electrical shocks through the chest wall to the heart muscle.

Medications: The patient suffering from a cardiac emergency, must be immediately taken to the hospital. When the patient reaches the hospital care, the doctors will use all possible methods and medications to stabilize the condition of the patient. These medications can include:

  • Thrombolytics to melt clots
  • Blood thinners to revitalize the blood flow by removing clots
  • Antiplatelet drugs to stop the creation of new clots
  • Pain killers to reduce discomfort immediately

Long-term treatment: In case a cardiac arrest has led to a major heart attack, the patient might have to undergo surgery to repair the damage and reinstate good health:

  • Angioplasty is done to clear the arteries by injecting a catheter (thin tube) via the artery. This catheter aims to open the blocked arteries and restore the blood flow
  • Placement of a stent to prevent the artery from closing again
  • The coronary artery bypass graft is done to redirect the bloodstream to reach the obstruction.
  • Remedial heart surgery to treat an inherited heart malformation

Overall, a cardiac emergency can be evaded with a healthy lifestyle and proper eating habits. Moreover, preventive medical check-ups help to detect any abnormalities time in advance.

The festival season and diabetes

India is a land of festivals. The period between October and January is full of festivities. For people with certain health conditions, particularly those living with diabetes, this is a highly testing time. India is currently termed the diabetic capital of the world with more than 70 million people living with this condition. It is important for people living with diabetes to focus on their treatment and management goals during the festive season too.

Que: What are the hazards to the patient with diabetes during the festival season?

The festival season includes periods of fasting and feasting. Many patients with diabetes fast for varying periods during this period.

One of the serious consequences of fasting is hypoglycaemia (very low blood sugar which occurs if the sugar level is less than 70 mg/dl). This can be potentially fatal and can have long term consequences and should be avoided at all costs.

The symptoms of hypoglycaemia include sweating, shaking, hunger, dizziness, palpitations and in extreme cases confusion, drowsiness and unconsciousness.

If the patient is conscious then he/she should immediately consume 15 grams of glucose or sugar followed by some snacks like fruits, biscuits, sandwiches. Fingerpick glucose check 15 minutes after taking the sugar should ideally be done to see if the blood sugar has risen to at least 90mg/dL or more and if not, the sugar intake has to repeated. If the patient is unable to take by mouth because of drowsiness or unconsciousness then he must immediately be taken to the nearest hospital.

On most occasions high blood sugar does not have immediate symptoms. Typically, very high blood sugar symptoms include excessive thirst, frequent urination, blurry vision, fatigue, dry mouth.

Que: Should patients with diabetes fast during festivals?

Ideally patients with diabetes should not fast. None of the religions mandate fasting for people who have illness. However, should anyone have a strong desire to fast then he must discuss this with his diabetes doctor. Some anti diabetes medications carry a low risk of hypoglycaemia and hence in such cases the diabetes doctor may make temporary changes to the medications to include those with the lowest risk of hypoglycaemia. However, patients on insulin and sulphonylurea group of drugs remain at a higher risk of hypoglycaemia during fasting.

Que: Do we need to change the diabetes medications during the festival season?

Discussing the medications with the diabetes doctor before the festivities will always help in reducing the swings of blood sugar during festivals. If needed your doctor may make minor adjustments to your medications. Particularly those on insulin will definitely benefit from pre festival advice. On some occasions your doctor may advice extra rapid acting insulin on days where more than usual amount of food is consumed. It is of vital importance that medications must be taken on time and the food should be taken as close to the usual routine of the patient as possible.

Que: Should patients with diabetes have sweet products during festivals?

There has to be balance as far as food consumption is concerned. If occasionally a sweet is taken then for that particular meal the amount of carbohydrate (rice, roti) should be reduced so that there is less rise of blood sugar. “Cold drinks” cause significant elevations of blood sugar and hence should be replaced with low sugar drinks like diet coke/diet pepsi. Sugar free products in moderation may be taken and one of the sugar free agents called sucralose is also heat resistant and may be added to hot drinks.

Que: What food should a patient with diabetes choose during festivities?

Carbohydrates are the type of food which in higher quantities causes blood sugar to go up. High carbohydrate containing food includes sweets, chow mien, noodles, pizza, idli, and high amounts of rice, roti, paratha. So, the trick is to take less food with high carbohydrate content. Instead more amounts of vegetables (any vegetables, few pieces of potato are allowed), dal, fish can be taken. Taking more amounts of salad and boiled vegetables before a meal gives a feeling of fullness leading to less consumption of high carbohydrate and fried food. This may not be applicable for patients with kidney disease. It is a good idea to reduce the portion size and include a variety of food groups. Any two fruits a day is allowed for patients with diabetes and hence fruit based desserts rather than sugar based desserts should be encouraged. Walking after a meal also helps burn up the extra calories. The exertion during the festivities may cause dehydration and hence it is important to consume adequate water to prevent dehydration. Alcohol, if consumed, should only be taken in moderation (not more than two “standard pegs in 24 hours) and should not be taken in an empty stomach as it may lead to hypoglycaemia (very low blood sugar) after a few hours.

There is no reason that a person with diabetes cannot enjoy the festivities during the festival season. Actually, nowadays the term “Diabetes diet” has been replaced by the term “Healthy diet”. Hence the above advice is just as applicable to the common population without diabetes. It is important however to keep a regular check on the blood sugar levels for peole with diabetes. So, best wishes for all the upcoming festivals !!

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