Chest pain that comes and goes

 

If chest pain worries you

If you have chest pain, they come and go and you want to know what causes them.

If you also suffer from recurrent chest pain and this issue worries you, read the following article.

 

Causes of chest pain

Epidemiology of chest pain

What are the risk factors for chest pain?

What are the causes of chest pain?

Other causes

What are the diagnostic measures in a person who suffers from chest pain?

Treatment of chest pain

When should we see a doctor?

 

Doctors consider chest pain to be one of the most common reasons for visiting medical offices and clinics. The chest is a structure bounded from the back to the upper vertebrae of the spine and from the front to the sternum. Twelve pairs of bony ribs are the interface between the spine and the sternum.

At the junction of the ribs to the sternum, there is cartilage that may become inflamed following viral infections, or traumas, or repeated heavy work with the arms. Costochondritis is an inflammation of this cartilage that can involve one or more ribs.

In these cases, the patient will develop chest pain that is localized to one or more specific points, and chest pain is exacerbated by deep breathing, coughing, or sneezing.

 

The intercostal muscles, the pectoralis's small and large pectoralis muscles, the intercostal nerves and arteries, along with the bones of the spine and ribs, and the sternum, form the skeletal structure of the chest.

The chest protects the right and left lungs, the heart and blood vessels, parts of the esophagus and thoracic aorta, and the branching vessels in the chest.

 

Causes of chest pain

So the causes of chest pain can be summarized in the following groups:

  • Causes of chest pain related to the musculoskeletal system
  • Causes of cardiovascular pain
  • Causes of respiratory pain related to the respiratory system

 

In addition to the above reasons, the following can also be mentioned:

  • Breast pain
  • Recurrent pain in the abdominal organs

 

Epidemiology of chest pain

The prevalence of new cases of chest pain per year is 5.15  people per thousand population.

The risk of chest pain is directly related to aging.

In men, especially with increasing age, the prevalence and incidence of chest pain will be higher. About 7% of all patients referred to the emergency department of hospitals are people with chest pain. Seventy percent of these patients have non-cardiac chest pain.

 

What are the risk factors for chest pain?

The following groups are more at risk for chest pain than others:

  • People with age (the risk of heart attacks that present with chest pain increases fivefold between the ages of forty and fifty).
  • Overweight people (increased abdominal diameter has been shown to be associated with an increased risk of severe and dangerous heart attacks).
  • Diabetics
  • People with hypertension
  • People with dyslipidemia
  • Tobacco users in any form
  • Sedentary people
  • fat people

 

If we want to look more specifically, the risk factor of each risk group will be as follows:

 

  • Acute coronary heart disease:
  • Being a man
  • Age over fifty years
  • Being diabetic
  • High blood cholesterol or hypercholesterolemia
  • Dyslipidemia or poor blood lipids
  • Hypertension
  • Being a smoker and consuming tobacco
  • Cocaine use

 

  • Aortic artery problems
  • High age
  • Patients with connective tissue disorders, such as those with Marfan syndrome
  • Hypertension
  • People after angioplasty or invasive surgery or cardiovascular surgery

 

  • Lung vascular problems such as pulmonary embolism:
  • People with underlying cancers
  • People with a history of chemotherapy
  • People with chronic cardiovascular disease
  • People with hereditary coagulation disorders that predispose them to clotting
  • pregnant women
  • fat people
  • People with a history of major abdominal and pelvic and lower pelvic surgeries

 

What are the causes of chest pain?

What factors can manifest themselves with chest pain?

What is the sign of a chest pain that comes and goes?

We said that we can classify the causes of chest pain into several groups according to the anatomy and structure of the chest. In the following, we will talk a little more about the above groups.

 

  • Cardiac causes that lead to chest pain:

The most common heart cause of chest pain is ischemic heart disease and disorders.

Ischemia in medicine means that not enough oxygen reaches the living cells of the body, and as a result of this reduction in oxygen supply, pain occurs in the tissue that has not received oxygen.

People with coronary heart disease, for example due to atherosclerotic plaques, narrowing and blockage of these arteries supplying blood to the heart wall are classified by doctors in the group of patients with coronary syndromes.

This group, which is acute coronary artery syndromes, is divided into several categories, which we will name and describe in the following.

Chest pain of cardiac origin is sometimes called angina

 

  • Stable angina:

Chest pain is a condition that occurs in people with mild to moderate coronary artery problems.

A person will only develop angina during exercise or physical activity, and generally the pain will be reduced and relieved by stopping physical activity or taking nitroglycerin sublingual tablets. Emotional stress can also lead to persistent angina. The pain usually starts in the back of the sternum and sometimes spreads to the lower jaw and abdomen around the navel, arms and shoulders, and even the hands. During this type of attack, the person is pale and restless, many people a few minutes after eating Heavy food may experience angina,

A person with stable angina may experience pain with the above characteristics several times, which can be relieved by taking nitroglycerin or stopping activity and resting.

The duration of this chest pain will be at least one minute or a maximum of fifteen minutes

 

  • Unstable angina:

As coronary artery stenosis progresses, the affected person will be in a position to develop angina even at rest.

Manifestations of persistent angina include:

  • Chest pain while sleeping or resting
  • Occurrence of chest pain without strenuous exercise and, for example, just following a daily routine.
  • Do not relieve chest pain by resting or taking sublingual nitroglycerin
  • Chest pain lasts for more than twenty minutes

 

Unstable angina can quickly lead to heart attacks, so seek immediate emergency care in the most serious circumstances.

 

  • Diseases and disorders of the aortic wall:

Aortic dissection is common in people with hypertension, especially smokers. In this disorder, the inner wall of the aortic artery ruptures, and cause severe and sudden pain in the chest. Aortic dissection is an emergency condition in which the chest pain is continuous, very severe, and similar to a ruptured chest.

 

  • Causes of chest pain originating in the respiratory system:
  • Pleurisy:

Inside the chest is a two-layer membrane called the pleura, the inner layer of which extends around the surface of the lung and the outer layer covers the inner surface of the chest.

The presence of any inflammation in any of these two layers can cause pleurisy.

In this condition, the chest will be painful when you inhale deeply, and the pain will intensify when you cough.

Infections and inflammations of the lungs, such as pneumonias, may be associated with inflammation of the pleura and crystals. Pneumonia and pleurisy may also occur in lung tumors.

 

 

  • Pulmonary embolism:

If a blood clot in one of the deep arteries of the body breaks, small pieces of it may reach the lungs through the bloodstream. Chest pain in a pulmonary embolism begins suddenly and is usually accompanied by an increase in the number of breaths and rapid shallow breaths, and the person may also experience a cough.

 

  • Pulmonary hypertension:

High blood pressure in the arteries that carry blood to the lungs may cause chest pain.

 

  • Chest pain originating in the gastrointestinal tract:

 

  • Gastric reflux (GERD):

The classic symptom of gastroesophageal reflux disease is heartburn.

Along with heartburn, most people have non-classical symptoms of gastroesophageal reflux disease, for example:

  • Sore throat
  • Tooth decay
  • Bad breath
  • Sputum behind the nose
  • Feeling of tightness in the throat
  • Need to clear the throat frequently
  • Chronic cough (a cough that lasts more than twelve weeks is called a chronic cough)
  • Voice change

 

  • Swallowing problems:
  • Inflammation of the inner wall of the esophagus or esophagitis
  • Esophageal tumors
  • Benign masses of the esophageal wall
  • Zenker diverticulum

They can be associated with difficulty swallowing or dysphagia. Sometimes, in cases where there is painful odynophagia, there may be pain in the chest that you sometimes feel when eating and swallowing.

 

  • Diseases and disorders of the gallbladder:

Inflammation of the gallbladder wall is called cholecystitis. Upper and right abdominal pains that sometimes spread to the right arm and shoulder are common in acute or chronic cholecystitis. We will have that in chronic cholecystitis you feel this pain as chest pain that comes and goes.

 

  • Inflammation of the pancreas or pancreatitis:

Inflammation of the pancreas occurs acutely or chronically and causes very severe pain in the abdomen that sometimes spreads back and forth. Sometimes pain related to pancreatic problems may be felt in the chest.

 

  • Causes of chest pain of musculoskeletal origin:

We said that trauma and damage and inflammation of the tissues that make up the chest wall can also cause chest pain. These pains are mostly focal and the affected person is able to localize the pain site with his finger or hand.

Most of these pains occur after lifting heavy weights, incorrect weight lifts or doing exercises in which the shoulders and arms are very active, and usually the duration of chest pain in these cases is less than one minute.

 

  • Rib damage:

They can cause inflammation of the outer membrane of the pleura and lead to pleurisy. Chest pain that is exacerbated by deep breathing is a sign of rib injury.

 

  • Sore muscle syndrome or fibromyalgia:

It may be accompanied by persistent and recurrent chest pain. People with this syndrome often complain of other pain in their musculoskeletal system. In addition, sleep disorders are more common in these people than in healthy people.

 

  • Costochondritis or inflammation of the cartilage at the junction of the ribs with the edge of the sternum:

In these cases, there may be one or more painful points that are perfectly aligned with the cartilage between the ribs and the sternum, which the patient completely localizes with the hands, and there may also be swelling and redness of the skin at the site of inflammation.

The pain may come and go in these cases, or it may worsen when you cough and change position or breathe.

 

Other causes

  • Chest zoster:

Burning pain in a specific area (dermatome) on one side of the chest precedes the onset of shingles skin symptoms.

Following the pain, the skin gradually becomes erythematous and typical shingles blisters appear that will be painful.

Sometimes there is pain for a long time after the skin lesions have healed

Generally, with shingles, which is the reactivation of the herpes zoster virus, there is generalized boredom and fatigue in the infected person.

 

  • Chest pain following panic attack:

Panic Attack Disorder can mimic the symptoms of a heart attack without a heart problem.

These people have a normal ECG during and after the attack.

Panic attacks will never lead to a heart attack or death

 

What are the diagnostic measures in a person who suffers from chest pain?

Obtaining a history and paying attention to the accompanying clinical signs and manifestations can lead physicians to a list of differential diagnoses. Based on the list of differential diagnoses, the physician uses observations and examinations such as the following depending on the condition and symptoms.

  • Observe the level of the chest in terms of assessing the presence of swelling and inflammation or shingles lesions.
  • Observe cervical arteries
  • Hearing the heart
  • Hearing the lungs
  • Hearing of the arteries inside the chest
  • Observation of the pharynx and direct observation of the larynx with a laryngoscope to evaluate the manifestations of gastric reflux
  • Examination of the legs for the presence of edema secondary to heart problems
  • Examination of the legs for DVT (deep vein thrombosis of the legs can lead to pulmonary embolism)

 

In addition to these examinations, the following modalities are used according to the circumstances:

  • ECG
  • Echocardiography
  • Simple chest x-ray
  • Chest CT scan
  • Chest CT angiography
  • Diagnostic therapeutic angiography
  • MRI
  • Abdominal ultrasound to evaluate gallbladder or pancreas problems
  • Abdominal X-ray
  • CT scan of the abdomen
  • MRI of the abdomen and pelvis

 

It should be noted that in cases where you have seen a doctor with one of the warning signs of cardiovascular and respiratory problems, saving your life will be preferable to the above diagnostic methods.

 

Treatment of chest pain

The type of treatment will depend entirely on the cause of the chest pain.

  • For gastric reflux:

It is necessary to follow the recommendations on diet and lifestyle modification along with following a proper medication diet, which can be a drug from any of the following categories:

  • Anti-reflux syrups
  • Magnesium hydroxide
  • Aluminum hydroxide or a syrup that combines both
  • Blocker H2 such as ratitidine, famotidine
  • PPIs On an empty stomach
  • For example, omeprazole, pantoprazole and…
  • Emergency heart attacks or pulmonary embolism will be treated

For gastrointestinal problems leading to chest pain, intestinal rest, dehydration, intravenous antibiotic therapy, and in some cases surgery may be used, depending on the underlying cause.

Costochondritis will usually improve with supportive treatment within a few days to a week. In these cases, it is recommended that the person stop any physical activity during which chest pain begins or intensifies, taking painkillers and anti-inflammatory drugs such as A group of NSAIDs such as naproxen and ibuprofen are recommended. In cases of pleurisy or rib fractures and pain that prevents deep breathing, the person should learn respiratory physiotherapy from their doctor so that they do not have other respiratory problems.

 

When should we see a doctor?

In the following cases, you should call the emergency room immediately or take yourself to the emergency room.

If accompanied by chest pain:

  • You have nausea
  • You have shortness of breath
  • You feel weak and tired
  • You have lightheadedness and irregular heartbeat
  • You sweat a lot

 

Know that many of the symptoms of angina mentioned above are similar to myocardial infarction, so consciously observe the above manifestations. In myocardial infarction, the duration of chest pain varies, but in most cases lasts as long as more than thirty minutes.

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