Overview of Chest Pain
There are many different causes of chest pains. Some of these causes are life-threatening and require immediate medical attention. Angina at rest, and heart attack caused by a blood clot in a coronary artery are the most common causes.
Any serious chest pain should receive prompt medical attention. Medications and treatments are available to improve the chances of surviving a life-threatening cause of chest pain, and the sooner these therapies are initiated, the greater the chance to prevent death.
The heart receives blood and oxygen from three coronary arteries. If a blockage develops in one of these arteries and prevents sufficient blood and oxygen to flow to the heart, chest pain can occur. The discomfort this causes is called angina. Angina is frequently brought on by physical exertion or stress, which increase the heart's demand for blood and oxygen.
Anginal pains usually last several minutes and typically are relieved by relaxing or stopping the activity that brought on the episode. Angina sometimes manifests as a feeling of tightness or pressure in the chest. The pains often are felt in the neck, jaw, back, and arms as well. Patients also may experience sweating or "clamminess," shortness of breath, nausea, and a feeling similar to indigestion.
Anginal pain that occurs only with exertion is usually caused by a fixed blockage in one or more of the coronary arteries. Pain that occurs without exertion (i.e., at rest) may result not only from plaque build-up, but also from a blood clot that has formed in the artery. If the blood clot grows to completely block the artery, it can cause a heart attack. Anyone experiencing angina at rest should seek prompt medical attention. Medications are available to help prevent blood clots from completely blocking the coronary artery and causing a heart attack.
Although a heart attack is classically associated with severe pain across the chest, many people feel only a tightness or squeezing sensation in the chest. The discomfort of a heart attack may be confined to the arm, upper back, neck, or jaw. Some people only experience a feeling of indigestion, nausea, shortness of breath, or sweating. The discomfort associated with a heart attack usually lasts several hours.
Anyone experiencing symptoms associated with a heart attack that last more than 15 to 30 minutes requires immediate medical attention. Medications and treatments can dissolve the blood clot and restore blood flow to the heart. The sooner these are administered, the more heart muscle can be saved.
A less common cause of chest pain originating in the heart is pericarditis, inflammation of the pericardium (the membrane that covers the heart). Pericarditis pains can be sharp or dull and can last days. They are sometimes worse when lying down and eased by sitting up and leaning forward. Pericarditis may be caused by a viral infection, but in many cases the cause is not determined.
If the cause of chest pain is unclear or suggests a life-threatening condition, go promptly to a hospital emergency room. People who may be having a heart attack or another life-threatening condition should not drive to the hospital and should call immediately for emergency attention. In many areas, emergency medical service is available by dialing 9-1-1.
An evaluation of the characteristics of the pain or discomfort is made to help identify the particular medical problem. Tests performed in the emergency room to help determine the cause of chest pain include electrocardiogram (ECG), chest x-ray, blood oxygen level, and certain blood chemical tests. When the chest pain is thought to be angina, other tests that may be performed include a treadmill stress test, nuclear scan, stress echo study, and cardiac catheterization.