Chest pain

Chest pain

Chest pain is the most common symptom with which heart disease is associated, though it is well known that all chest pain may not be due to heart disease. The characteristics of chest pain are important in differentiating the causes. History is most often the only tool to evaluate chest pain as physical findings may be lacking.

  1. Location: Usually chest pain of cardiac origin is central and described as retrosternal
  2. Nature of pain: Pain due to myocardial ischemia (angina) is described as a crushing pain or heaviness in the chest. Pericardial pain may be felt as a superficial pain.
  3. Radiation of pain: Anginal pain may radiate to any region between the lower jaw and umbilicus, though typical radiation described is to the left arm. There are persons who complain only of pain in the jaw, wrist or elsewhere. When pain occurs only in the sites of radiation, without chest pain, it is one of the anginal equivalents.
  4. Aggravating and relieving factors: Myocardial ischemic pain in stable effort angina pectoris is brought on by exertion and relieved by rest. Myocardial ischemia means a decrease in the blood supply to the heart or a lack of blood supply in proportion to the demand. But the chest pain is persistent in case of myocardial infarction (heart attack) and unstable angina. Pain due to pericarditis may increase on inspiration if there is associated pleural involvement. Pain of pericarditis may be relieved by sitting and leaning forward. Pericardial pain can be associated with pain during swallowing (odynophagia) as the inflamed posterior pericardium overlies the esophagus.
  5. Associated symptoms: Excessive sweating is often associated with chest pain in myocardial infarction. Nausea and vomiting may also occur just like in any other visceral pain. Dizziness and palpitation are other possible associations.

It is important to differentiate cardiac from non-cardiac causes of chest pain, though it may not always be possible without the support of investigations.

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