Dr Araz Rawshani

All about chest pain: causes, types, and management of chest discomfort

Contents

Chest pain (discomfort)

If you get pain in the chest, it can have many different causes. One of the most common is that the muscles of the chest hurt because you have strained them more than otherwise. Also psychological tension can create a feeling of pain or discomfort in the chest. Sometimes the chest pain can be due to diseases of the heart, stomach or muscles. A strong, pressing pain in the chest can be symptoms of angina pectoris or myocardial infarction, and then it is important to seek medical help.

If you are not sure what causes the chest pains, it is best to have a doctor conduct an examination. Then you will have to describe your symptoms, your life situation and if you have had any illnesses in the past. The doctor then conducts a body examination and listens to the heart.

Symptoms

Chest pain can be felt in different ways depending on the cause that you have pain. Read more about various causes of chest pain in the chapter “Why do I have chest pain?”.

When should I seek medical care?

Call the emergency medical service in the following cases:

  • you have a strong, pressing or convulsive pain in the chest that does not disappear within a quarter of an hour;
  • you have a diffuse but unpleasant sensation in the chest that lasts for more than a quarter of an hour and that does not have a natural, harmless explanation
  • you have chest pain and at the same time feel shortness of breath, nausea, cold sweat or have irregular heartbeats.

If you do not need to seek emergency help, but still feel chest pain that does not have a natural explanation, you should contact a medical center.

You can apply for medical care at any health center you want throughout the country. You also have the opportunity to get a permanent medical contact at the health center.

Call phone number 1177 if you want medical advice. This will help you assess symptoms or help with where to seek treatment.

You have the right to understand

In order to be able to participate in your care and make decisions, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. You can also ask for information printed so that you can read it in peace. If you do not speak Swedish or have a hearing loss, you may be entitled to help from an interpreter.

Investigations and investigations

To see how the heart works, a resting ECG and a working test are often taken when the ECG is recorded under effort.

Because chest pain can have so many different causes, you must first describe your life situation, your previous illnesses and your symptoms. The doctor conducts a body examination and listens to the heart.

An ECG can give answers

To see how the heart works, a resting ECG and a working test are often taken when the ECG is recorded under effort. An ECG can show, among other things, whether the heart muscle suffers from oxygen deficiency, which is a clear sign of angina pectoris.

Chest X-ray

If your doctor suspects pleuritis or that you have air in the pleura due to a rupture of the lungs, you may undergo an X-ray examination of the lungs.

Ultrasound examination

An ultrasound examination of the heart, echocardiography, can, among other things, show whether there is an increase in the amount of fluid in the pericardium. It may indicate pericarditis. The examination can also show whether there is a malfunction of any heart valve or heart muscle.

Blood tests

Cells in the heart muscle that have been damaged or died from oxygen deficiency release different proteins that do not leak from healthy cells. Proteins can be measured by various blood tests.

Coronary angiography

Through coronary angiography, the doctor will see if you have constrictions in the vessels that can cause angina.

A thin plastic tube, called a catheter, is passed through a blood vessel in the groin or arm, up to the coronary arteries of the heart. When a contrast agent is injected, the constrictions that may be present in the vessels are visible.

Investigations of the lungs

If there is a suspicion of a thrombus in the lung, called pulmonary embolism, you may undergo one of the following examinations:

  • Chest X-ray
  • Computed tomography
  • Ultrasound examination
  • Isotopic examination
  • Contrast X-ray.

In the examinations, various types of X-ray cameras are used. Often the image needs to be more detailed, using contrast agents that are usually not transparent on X-rays. Sometimes also ultrasound examination of the heart can be used if the doctor suspects a large blood clot.

Gastroscopy

If you have stomach pain or other signs that may indicate a stomach hernia or a stomach ulcer, you may have a gastroscopy.

A gastroscopy means that you first receive local anesthetics in the pharynx and a relaxing drug. Then a tube is passed through the mouth and throat into the stomach. Through the hose, both photographs and different kinds of tissue samples can be taken.

Examination of the biliary tract

Gallstones, especially if stuck in the bile ducts, can affect the liver. Therefore, blood tests are taken that show how the liver works.

To investigate more closely if there are gallstones in the gallbladder or bile duct, an ultrasound or contrast X-ray may need to be done.

Treatment

In the first place, heart problems are treated with drugs that reduce stress on the heart and increase blood flow in the coronary arteries. They also relieve pain, shortness of breath and fatigue.

If you have angina, it may be necessary to widen your coronary arteries so that your heart gets better blood supply. The procedure is called balloon angioplasty after the small balloon used to expand the constriction. The procedure is often shortened PCI.

You may also undergo coronary artery intervention or bypass surgery. Then the blood is passed past the constriction of the coronary arteries through blood vessels that are moved from other parts of the body and sewn to the coronary arteries.

If you have a heart valve that causes a narrowing or leakage in the opening between the left atrium and the ventricle of the heart, it may be necessary to replace the valve during surgery. This also applies if you have a narrowing or leakage in the opening between the ventricle of the heart and the trunk, aorta.

It is also possible to replace a narrowed valve with puncture of blood vessels, so-called catheter technique. The procedure can then be done without open heart surgery. It is called TAVI and is often used in elderly and fragile patients.

Treatment of lung diseases

Some blood clots in the lungs should be treated with propple-soluble drugs. This is especially true of large blood clots or those that sit in particularly sensitive blood vessels. First, medicines are given in droplet form, and then you switch to medicines in tablet form.

A lung bladder that has burst usually heal by itself. In more severe cases, air in the pleura is sucked through a tube through the chest. In some cases, surgery is also required.

Pleuritis usually heals by itself and you are given painkillers for pain. Sometimes you also get antibiotics.

Treatment of stomach diseases

Symptoms of a hernia of the diaphragm can be treated with drugs that suppress the production of acid in the stomach. You will also receive advice on what to avoid eating and drinking. If the treatment does not help, and if the symptoms are very severe, you may have to undergo an operation to restore the function of the upper stomach.

In case of stomach ulcers, you will be given medicines to reduce acid production in the stomach. Nowadays antibiotics against the bacterium helicobacter pylori are also most often given. It is rare that surgery against stomach ulcers needs to be done.

Against gallstones, no treatment is often needed for the sake of stones. If the gallstones cause cramping pain, you will be given medicines for the pain. If the gallbladder suffers from inflammation, and often at the same time infection, the disease must be treated with medications or with surgery. In the operation of the gallbladder, the entire bladder is removed. Gallstones stuck in the bile duct most often have to be removed, and operation, as a rule, becomes necessary.

Treatment of muscle diseases

Temporary muscle inflammation often does not need to be treated. If the pain is severe or lasts longer, painkillers or anti-inflammatory drugs can benefit.

If prolonged muscle pains are due to psychological tension, anxiety or depressed mood, it is important to try to influence the very cause of the psychological disorders. At a medical center you can get advice on where to go. Prolonged muscle pains associated with stressful or one-sided work may require changes in the workplace. Occupational health care plays a big role.

Sometimes muscle pain can be so awkward that it may be necessary to rest from work and perhaps get help from a physiotherapist.

Treatment of shingles

The infection heals by itself, but you may need painkillers for the pain.

Treatment of panic disorder

Panic disorders have psychological causes that can sometimes lie far back in time and are triggered by one or more events. Since anxiety is more difficult to live with than many bodily diseases, it may be important to get help with treatment quickly. If you are aware of your anxiety and want help, contact a psychologist, counselor or psychiatric doctor. If you come to a doctor in a medical center or hospital, you often get a referral to one of these professionals. Treatment usually consists of a combination of supportive conversations, some kind of psychotherapy and drugs.

Why do I have pain in my chest?

Here are the most common causes of chest pain:

Angina

The cause of chest pain in angina is usually that one or more coronary arteries have suffered from varicose veins, which is also called atherosclerosis. The coronary arteries become narrower and let less blood through to a part of the heart muscle.

Myocardial infarction

In a heart attack, the narrowing of the blood vessels has led to a complete stop of blood flow in one of the coronary arteries of the heart.

Inflammation of the pericardium and inflammation of the heart muscle

Pericarditis can occur from a viral infection. Simultaneously with the inflammation, you may also have heart muscle inflammation. Viral infection usually means that you have symptoms of flu or sore throat at the same time, but sometimes you may have only inflammation of the pericardium or heart muscle.

Heart muscle disease or enlargement of the heart muscle

The disease is due to the fact that the heart muscle grows in an abnormal way. A common cause is hypertension.

Rupture of the vascular wall of the large organ artery

The wall of the large body, aorta, vascular wall can burst. One of the reasons why it happens is atherosclerosis, but it can also be due to a congenital weakness of the vascular wall itself.

Blood clots in the lung (pulmonary embolism)

Blood clots can form in the veins, the blood vessels that bring the blood back to the heart from different parts of the body. The risk of getting blood clots in the legs is greater than usual during and after an operation and in conjunction with some other diseases, such as, for example, tumor diseases. If you sit still for a long time, for example during a long flight, the risk also increases.

Blood clots often form in the legs, but can also occur in other parts of the body. Part of a blood clot or the entire blood clot may loosen and pass through the blood veins to the blood vessels of the lungs. The blood clots in the lungs that then occur are called pulmonary embolism.

Rupture of pulmonary vesicles

Small pulmonary vesicles may burst even in a healthy person, but stretch marks are much more common in older people with a lung disease in which the pulmonary vesicles are enlarged. It can occur even in younger people, but often in people who play sports.

Pleuritis

Often pleurisy is due to a viral infection, but sometimes it can be caused by pneumonia, or by some allergic diseases.

Diaphragmatic hernia or esophageal catarrh

A hernia can cause the upper stomach to not close completely, and then acidic gastric contents leak from the stomach into the esophagus. The mucous membrane of the esophagus does not tolerate the acid and reacts with inflammation and spasm. You may also suffer from ulcers of the esophagus.

Gastric ulcer

An ulcer can occur in the mucous membrane of the stomach or in the duodenum. Peptic ulcer is caused, among other things, by a bacterium, helicobacter pylori.

Gallstones and gallbladder inflammation

In the gallbladder, bile is formed, which affects digestion. Bile goes from the gallbladder, out through a narrow gait, and is emptied into the duodenum. It can form hard stones, gallstones, in the gallbladder. Gallstones can pass out through the bile duct, but can also get stuck there.

Gallstones can also lead to an inflammation of the gallbladder, and sometimes to acute inflammation of the pancreas.

Muscle aches and inflammation of the muscles

There are many different causes of muscle pain. Several different types of tension in the muscles of the chest can also cause chest pain. Muscle tension, often prolonged, is common in connection with mental tension, anxiety and depressed mood. Prolonged mental tension can lead to prolonged muscle inflammations in the chest and other muscles.

Tietze Disease

Tietze’s disease is an inflammation of the thoracic muscles and in the periosteum of the sternum.

Symptoms can often be provoked when pressing on the sternum

Herniated disc of the cervical spine

The cervical spine consists of the seven upper vertebrae of the spine, which are particularly mobile for easy turning of the head. Those who work for a long time in unsuitable posture may have changes in the joints between the cervical vertebrae and in the softer discs, so-called disks, which are located between each vertebra. Virtually all people suffer similar changes with increasing age.

Age changes in the cervical spine can lead to severe pain if pressure occurs on one or more of the nerves exiting between the cervical vertebrae to the arms and chest. Pressure can also be caused by weakening and bulging of the discs between the vertebrae, a herniated intervertebral disc of the cervical spine.

Shingles

Shingles are caused by the same virus as chickenpox, and manifests itself as rashes on the skin.

Mental disorders

Anxiety, anxiety, depressed mood and tension conditions that have psychological causes can lead to acute palpitations, chest tightness and shortness of breath.

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