Angina pectoris
Angina pectoris causes sharp chest pain. This happens because the supply of oxygen and nutrients to the heart is insufficient compared to what the body needs. Some people only experience the phenomena after exertion where the need for oxygen is increased, but the oxygen supply is decreased – for instance because of arteriosclerosis – and thus the oxygen levels cannot rise sufficiently. On the other hand, the vessel is still wide enough to allow sufficient oxygen to supply muscle activity when at rest, and here the patient is pain free.
In addition to arteriosclerosis, enlarged heart, heart valve disease and vasospasms (narrow blood vessels) can result in reduced oxygen supply. Pericarditis, aortic dissection and mitral valve prolapse can cause chest pain as well, even if the heart’s oxygen supply is not reduced. Some people experience the pain when at rest without knowing how to relieve the symptoms, which often indicates a more serious condition. Heart-related chest pain is often described as a sharp, prolonged and squeezing pain behind the breastbone and sometimes as a fist pushing against the breastbone. The pain may spread to the left shoulder and arm as well as neck, jaw and between the shoulder blades. It is often associated with diaphoresis (sweating), muscle weakness, nausea, and vomiting. In addition, some heart patients often experience difficulty breathing, and fainting.
Regardless of when and how the chest pain occurs, intense heart pain is a serious symptom, and in this situation medical assistance should be sought immediately.
Other causes of chest pain
Chest pain is, however, not only a sign of heart disease. It can also be due to diseases related to other organs near the heart without involving the heart, and some conditions are more serious than others. The pains might seem similar and they are often described as almost identical – however, some characteristics do set them apart.
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The oesophagus
Chest pain caused by gastrointestinal conditions are related to the oesophagus, stomach ulcers, pancreatitis and inflamed bile ducts. Acid reflux gives a sharp, burning pain known as heart burn which becomes worse when lying down and after meals. In addition, patients with acid reflux will often experience chronic coughing and difficulty swallowing, and regurgitation which is a sour or bitter-tasting acid backing up into your throat or mouth. In general, oesophageal disorders will often worsen when you swallow and not during physical exercise, as opposed to angina pectoris.
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The membrane that covers the lungs
Chest pain can also be caused by diseases related to the membrane that covers the lungs. This pain is different from angina pectoris as it varies in intensity depending on breathing cycle. It is worse during inspiration, where the lungs expand, and during coughing. The pain is sharp, often one-sided and not as diffuse as heart-related pain. In addition, the pain becomes worse during movement, and for this reason, you lie completely still and breathe shallowly when the chest pain is due to this condition, known as pleurisy.
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Muscle and bone
Furthermore, the pain can be due to musculoskeletal conditions, such as a broken rib, costochondritis (inflamed ligaments between ribs and breastbones) or nerve compression. Here the pain will increase when you feel the chest or move the rib cage passively. It is often easy to localise the pain precisely.
Thus, chest pain can be due to both conditions related to the heart and other organs – some conditions are more serious than others, and with the above-mentioned characteristics setting them apart. However, determining the cause of chest pain is not always an easy task, and therefore further examinations are often necessary.
Sources:
http://www.turner-white.com/memberfile.php?PubCode=hp_apr04_cardiac.pdf
