22nd September, 2019
Chest pain is common, but not all of cases of it are life-threatening. Dr. Mansoor Husain, a cardiologist and professor at the University of Toronto’s faculty of medicine, said the causes of chest pain can vary depending on several factors.
“The number of different sources of chest pain in a young person are different than they are in an old person,” he said. “A child having chest pain is not the same as a middle-aged obese smoker having chest pain.”
He added the causes of chest pain are a long list, and the way doctors approach chest pain is by looking at risk factors associated with the patient.
Coronary chest pain
One type of chest pain is coronary chest pain. “That’s caused by your heart not getting enough blood supply [and] oxygen because you’ve got coronary artery disease,” he explained, adding it’s one of the causes of chest pain that can be dangerous.
“Coronary chest pain can present in many different ways… we call them typical or atypical.”
A typical case can include a central heavy, pressured chest pain that’s brought on by exertion, he said, but once the artery is closed, exertion is no longer required.
“You could be having pain just sitting at rest,” he said, “and that’s a real red flag.”
Then there are associated symptoms in addition to chest pain including shortness of breath, sweating or nausea.
“If I hear any of those buzzwords, in addition to chest pain [like] I feel shortness of breath or a sense of doom… that to me is a heart attack until proven otherwise.”
However, again, factors like age matter. If he heard similar symptoms from an 18-year-old, Husain says it’s unlikely they have coronary disease.
Then there are people who have coronary chest pain, but it’s not typical.
“It’s well known women often don’t present the same way men do,” Husain explained, adding women can still feel pressure or tightness in their chest.
“Women have far higher incidences of atypical chest pain… their pain may not be as severe or typically characteristics of exertion.”
He says women may think they are feeling anxious — but in reality, they are having coronary chest pain.
“They are more likely to present with atypical symptoms rather than typical symptoms, but that doesn’t mean that they can’t present typical symptoms.”
Other groups that present atypical symptoms can include the elderly and diabetics. “Diabetics have two to three times the risk of coronary disease.”
They, like the elderly, could complain about fatigue or tiredness, he added.
Then there are life-threatening causes of chest pain. These can include clots in the lung (pulmonary embolism), he said, which can cause sharp chest pain or shortness of breath.
“It can also be positional, so [patients] only feel it in one position and not in the another,” Husain said.
Women on birth control and people who have taken long flights or drives can be more at risk of developing clots.
Another severe cause of chest pain is aortic dissection.
“This life-threatening condition involves the main artery leading from your heart (aorta)… If the inner layers of this blood vessel separate, blood is forced between the layers and can cause the aorta to rupture,” experts at the Mayo Clinic noted.
Gastrointestinal-related chest pain
Some people can feel chest pain if they are having gallbladder issues like gallstones, even though the gallbladder is not located anywhere near the chest.
More common causes include acid reflux, where heartburn is a common symptom. The Mayo Clinic added this burning sensation happens when stomach acid moves up your stomach into the esophagus.
Other causes of chest pain can include esophageal spasms, which can feel like a heart attack for some.
“These are lower down on the list, not [because they are] necessarily less common, but because they’re not as immediately urgent,” Husain explained.
Sometimes, the type of pain can also be different for GI-related chest pain compared to heart-related issues. Some feel more of a burning sensation, for example, but often, when people feel this type of chest pain for the first time, Husain said many people don’t know how to react.
Other causes of chest pain can include muscle strains or a rib-related issue like costochondritis (inflammation of the cartilage in the rib cage).
For anyone who has experienced a panic attack or anxiety attack, chest pain is often a symptom. For some, it can even feel like a heart attack.
One 2002 study found chest pain was a common symptom of panic attacks.
“Persons with panic disorders (PD) often present to acute care settings or to cardiologists for evaluation of their chest pain,” authors noted.
“Given the high incidence of PD and the existence of effective treatments, it is imperative that physicians recognize and treat PD in patients presenting with chest pain.”
Husain says when a person is anxious, they feel shortness of breath, sweaty and their pulses racing.
“It is the incredible ability of our bodies and our flight and fright response to go into overdrive,” he said, which causes some people to feel chest pain and experience thoughts of passing out. Talking to your doctor about your history with anxiety, depression or even panic attacks can help rule out heart-related issues.
And while chest pain can be both a rare event or common occurrence, Husain explains some people just ignore it.
“I think people will often ignore symptoms… but people know themselves better than doctors know them.” He says when you are feeling unlike yourself, you should see a doctor as soon as you can.”
*Dr. Husain spoke with globalnews.ca