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Chest Pain: 11 Causes, Symptoms And Treatment Options
Chest pain may indicate a number of health conditions.
Heart AttackCoronary artery disease (CAD), which occurs when blood flow to the arteries is compromised by a narrowing and hardening of the arteries, can cause a myocardial infarction (heart attack), and chest pain is one of many potential symptoms of this medical event. "Chest discomfort due to CAD is usually diffuse (widespread) and difficult to localize," explains Dr. Jean. "It's also worse with exertion or emotional stress and relieved by rest."
PericarditisPericarditis occurs when the pericardium, a two-layer structure of tissue that surrounds and protects the heart, becomes inflamed due to an infection, a heart attack, certain medications, heart surgery or an injury or medical condition. The pericardium holds the heart in place and helps it function appropriately, and if it becomes inflamed, it may rub against the heart.
Pericarditis commonly causes chest pain similar to that of a heart attack, says Alexandra Kharazi, M.D., a cardiothoracic surgeon at CVTS Medical Group Inc. In San Diego and author of The Heart of Fear, a book about her experiences as a surgeon.
AnginaAngina occurs when the heart isn't getting the blood volume it needs, often resulting in chest discomfort or pain. As well as feeling pain in the chest, some people with angina experience pain in other parts of the body, such as the shoulder, neck, jaw, arms or back, as well as sensations like pressure or squeezing in the chest similar to indigestion. Angina becomes serious when symptoms don't dissipate when a person is resting, an indication that they need urgent care.
Aortic Dissection or RuptureAn aortic dissection occurs when a tear in the wall of the aorta, the heart's main artery, gets bigger. As the tear grows, blood starts to flow between the layers of the wall of the blood vessel. The tear can also inhibit blood flow to important branches of the aorta, potentially leading to additional symptoms like stroke, abdominal pain or leg pain and weakness, according to experts. Chest pain experienced during an aortic dissection or rupture is usually sharp and sudden and may have a stabbing or ripping quality. The discomfort usually occurs below a person's breast bone initially but often moves into the back or shoulder blades.
Heart Valve DiseaseHeart valve disease occurs when the valves in the heart stop working properly because they're damaged or because of an underlying health condition. While many people with heart valve disease don't experience symptoms, some may experience chest pain and heart palpitations, as well as fatigue, lightheadedness and shortness of breath.
Pulmonary EmbolismA pulmonary embolism occurs when a blood clot from another part of the body breaks loose and enters the lungs, where it blocks blood flow and inhibits oxygen flow through the body. Chest pain caused by a pulmonary embolism can mimic that of a heart attack, and the condition can be fatal. Certain populations are at a higher risk of developing a pulmonary embolism, including anyone with a prior history of the condition, people who are inactive for long periods of time and those with certain medical conditions, such as heart disease, COVID-19, lupus, interstitial lung disease and some cancers. Smoking, pregnancy, and medications containing estrogen can also increase a person's risk.
Gastroesophageal RefluxGastroesophageal reflux, also known as acid reflux or GER, occurs when the contents of a person's stomach rise into their throat, causing heartburn and indigestion that may manifest as chest pain. Acid reflux is usually temporary but may become gastroesophageal reflux disease (GERD), a chronic condition.
AsthmaAsthma is a disease that causes intermittent airway inflammation, potentially leading to chest tightness or pain, breathlessness, wheezing and coughing.
Musculoskeletal Pain or CostochondritisSometimes chest pain can stem from the muscles and structures of the chest. For instance, costochondritis occurs when the cartilage between a person's ribs and their sternum becomes inflamed, leading to chest pain. Musculoskeletal chest pain may also stem from the body's muscles or bones, referred pain from other areas of the body or traumatic injuries to the chest, such as broken ribs.
Anxiety or StressA number of anxiety and stress conditions can result in chest pain. Generalized anxiety disorder, panic disorder and social anxiety disorder can all cause a feeling of chest pain, often as a result of stress or navigating stressful situations.
Chest InfectionsA wide range of infections may cause chest pain, including pneumococcal disease and acute bronchitis. These conditions are usually accompanied by other symptoms, such as coughs, fevers and difficulty breathing. COVID-19 may also lead to chest pain in some cases.
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Heart Attack
SOURCES:
Photo Credit: BSIP/Medical Images
American Heart Association: "Warning Signs of Heart Attack, Stroke & Cardiac Arrest," "Heart Attack Recovery FAQs," "Symptoms and Diagnosis of Heart Attack," "Lifestyle Changes," "Smoking: Do You Really Know the Risks?" "Professional Dental Cleanings May Reduce Risk of Heart Attack, Stroke," "Recommendations for Heart Health," "Lifestyle Changes for Heart Attack Prevention," "Angina Pectoris," "What is a Heart Attack?" "What Is a Cardiac Arrest?" "Understand Your Risks to Prevent a Heart Attack," "Warning Signs of a Heart Attack."
National Heart, Lung, and Blood Institute: "Heart Attack," "Life After a Stroke," "Life After a Heart Attack," "How Is Coronary Heart Disease Treated?" "How Does Smoking Affect the Heart and Blood Vessels?" "Strategies to Quit Smoking," "What Is Cardiac Rehabilitation?" "What Are the Warning Signs of a Heart Attack?" "Delay Can Be Deadly," "Call 9-1-1," "Emergency Medical Personnel," "Plan Ahead," "Heart Attack Survival Plan," "What Is Angina?" "How to Use an Automated External Defibrillator."
Mayo Clinic: "Heart attack," "Strategies to Prevent Heart Disease," "Protecting Women's Hearts: An Interview with a Mayo Clinic Specialist," "Heart Attack: First Aid," "Heart Palpitations," "Heart attack symptoms: Know what's a medical emergency," "Silent heart attack: What are the risks?"
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What Is Coronary Artery Disease?
Medically reviewed by Christopher Lee, MD
Coronary artery disease (CAD)—sometimes also called coronary heart disease or ischemic heart disease—is a type of heart disease that occurs when the blood vessels (also called arteries) that feed the heart become narrow. The most common cause of CAD is atherosclerosis, which is the buildup of cholesterol plaque in your arteries. When your arteries become narrow enough to impair blood flow to the heart, you can experience symptoms like chest pain and shortness of breath.
Researchers estimate that 5% of adults over the age of 20 in the United States live with CAD. If you're experiencing symptoms of CAD or have a family history of heart disease, it's essential to see your healthcare provider or cardiologist (a doctor who specializes in heart disease) for proper testing. Treatment consists of medication and lifestyle changes, but sometimes includes surgery. Without treatment, you may be at risk of complications like heart attack, heart failure, and even death.
SymptomsThe most common symptom of coronary artery disease is angina (or, chest pain). Your chest pain may cause you to feel pressure, squeezing, and tightness. It's also common to feel like something heavy is sitting on top of your chest. But, angina may also cause discomfort in other parts of the body, such as your arms, jaw, upper abdomen, and back.
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Aside from chest pain, you might also experience:
CausesThe primary cause of CAD is atherosclerosis—a condition that occurs when there is too much build-up of cholesterol in your arteries. As a result of the build-up, your blood vessels can become too narrow and create blockages that affect how easily blood can flow to your heart. Atherosclerosis not only causes CAD, but may also increase your risk of a heart attack, blood clots, heart failure, and arrhythmias (or, irregular heartbeats).
Risk FactorsWhile atherosclerosis is the most common cause, other biological and environmental factors may also increase your risk of experiencing symptoms of the disease. These risk factors include:
DiagnosisIf you have symptoms of CAD, it's in your best interest to see your healthcare provider as soon as possible. During your appointment, they will take a detailed medical history to learn about your symptoms and perform a physical exam. They can also order a variety of tests to determine whether atherosclerosis is present and whether or not you're experiencing a restriction of blood flor to your heart.
Your provider may use one or more of the following diagnostic measures to better understand your condition and overall heart health:
Electrocardiogram (ECG/EKG): Records the electrical signal from your heart to show if you have an impairment in your blood flow or scarring of the heart
Echocardiogram: Uses an ultrasound to view the heart and assess its function
Stress tests: Asks you to walk or jog on a treadmill to understand how your heart responds to stress during exercise
Cardiac computed tomography angiography (CTA): A special type of CT scan of the heart that uses contrast dye and X-rays to see if there's anything blocking your arteries or to measure build-up of cholesterol
Coronary angiography: Involves the use of catheters that your provider inserts into your blood vessels (typically in your leg or wrist) to take X-ray photos of the coronary arteries
If you received a diagnosis for CAD, your healthcare team will help you figure out the treatment that is right for you. The most common treatment options include lifestyle changes and medications. Depending on how severe your condition is, your provider may sometimes recommend a surgical procedure. Your exact treatment plan will depend on a variety of factors like the symptoms you're experiencing, your age, and whether you have any other health conditions.
In addition to treatment, some providers also recommend entering cardiac rehabilitation, which is a structured and supervised exercise program that teaches you how to exercise safely with CAD and advises you on how to incorporate healthy lifestyle changes into your daily routine.
Lifestyle ChangesAn important way to treat CAD is through healthy lifestyle choices. These may include:
Eating a heart-healthy diet: Try an eating plan that is high in vegetables, fruits, whole grains, and legumes, and low in saturated and trans fats, processed foods, salt, and sugars
Get moving: Do your best to incorporate 150 minutes of moderate exercise or physical activity per week
Sleep well: Get enough rest through the night to reduce stress levels and symptoms of CAD
Avoid harmful substances: Limit your intake of alcohol and quit smoking—or reach out for care from your provider if you need support on how to make these changes
Your healthcare provider may prescribe one or more of the following medications to reduce your symptoms and prevent the risk of heart attack, stroke, or death:
Statins and other medications that lower cholesterol
Antiplatelet medications like Bayer (aspirin)
Beta-blockers
Calcium channel blockers
Nitrates
ACE-inhibitors and angiotensin receptor blockers (ARBs)
Medications that control high blood pressure such as Zestril (lisinopril) and high blood sugar such as Glucophage (metformin)
If lifestyle changes and medication aren't improving your symptoms or slowing the progression of your disease, your provider may consider surgery. Some options for surgical procedures include:
Cardiac catheterization: Uses X-rays and contrast dye to recognize where there are blockages in the artery. Once your healthcare provider identifies the affected arteries, they can use a catheter and tiny balloon to open up an artery that has become too narrow to restore blood flow.
Coronary artery bypass graft (CABG): A type of open heart surgery that bypasses blocked arteries by creating a new path for blood to flow to your heart.
Prevention strategies for CAD look very similar to lifestyle changes you might have to make if you receive a diagnosis for the condition. As such, it's important to start practicing these habits early in order to prevent you from developing this heart disease.
These lifestyle changes may include:
Making meals that include vegetables, fruits, whole grains, and legumes
Limiting foods that are heavily processed or include saturated fats, sugar, and salt
Moving your body throughout the week
Getting enough sleep at night
Avoiding alcohol and tobacco use
Researchers are also investigating the relationship between air pollution and heart health, but early studies show a strong association between the two. That said, avoid air pollution when possible, such as by not exercising outdoors when air quality levels are poor. Another important way to prevent CAD is to monitor and treat underlying conditions like diabetes, high blood pressure, and high cholesterol—all of which can increase your risk of heart disease.
ComplicationsCAD is a serious condition that can lead to life-threatening complications. Treatment for CAD can help lower your risk of these complications. But without proper treatment, your chances of experiencing the following complications may increase:
Living with CADCAD is the most common type of heart disease and the leading cause of death in the U.S. Regardless of sex. Your prognosis (or, outlook) with CAD varies greatly depending on how severe your condition is and the symptoms you're experiencing.
Living with heart disease can be especially challenging. Symptoms of CAD can impair your quality of life and make it difficult to perform physical activities. If you receive a diagnosis for CAD, treatments often include medications that may come with potential side effects.
However, with support from your healthcare team and loved ones, you can learn to better manage this condition, reduce its symptoms, prevent your risk of complications, and improve your quality of life. Thankfully, research on CAD has advanced greatly and studies are still underway to learn about more treatments and prevention strategies that can reduce your risk of the condition and slow down the progression of the disease.
Frequently Asked QuestionsDoes coronary artery disease affect your life expectancy?
Coronary artery disease decreases your life expectancy. But, life expectancy depends on a variety of factors like age, the severity of disease, other medical conditions you have, and whether you're following your treatment plan.
What is the difference between coronary heart disease and coronary artery disease?
Coronary heart disease and coronary artery disease are different terms for the same condition. They refer to blockages in the coronary arteries that feed the heart. This is the most common form of heart disease, and can lead to heart attack, heart failure, and arrhythmias.
At what age is coronary heart disease more common?
The risk of coronary heart disease increases with age. People over 65 years of age are most at risk of dying from a heart attack. However, younger people can experience coronary heart disease too—especially if there are risk factors like a family history of heart disease at a young age.
Does coronary artery disease mean heart failure?
Coronary artery disease and heart failure are two different conditions that affect the heart. Heart failure is a condition that affects the heart muscle's ability to provide effective blood flow to the body, causing symptoms like shortness of breath and swelling. Coronary artery disease, on the other hand, refers to blockages in the blood vessels that feed the heart. Coronary artery disease can lead to heart failure since the heart muscle relies on blood supply to function.
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