Chest Pain: Causes, Symptoms, and When to Consult a Physician
Chest Pain
Chest pain can be a symptom of various health problems and may sometimes require urgent medical intervention. Since it can arise especially due to serious conditions related to the heart and lungs, it is important to take chest pain seriously. A significant portion of emergency department visits worldwide occur due to chest pain.
What Are the Main Causes of Chest Pain?
Chest pain can have a wide variety of sources. The most serious among them are heart and lung diseases, but many milder or temporary causes can also lead to pain.
Heart-Related Causes
Heart attack (myocardial infarction): Occurs as a result of blockage in the vessels supplying the heart; usually presents with a feeling of pressure, tightness, or very severe pain.
Angina: Pain felt as pressure or fullness, especially during exertion, due to reduced blood flow to the heart.
Aortic dissection: Sudden and severe chest pain develops as a result of tearing of the aorta.
Pericarditis and myocarditis: May develop due to inflammation of the heart membrane or heart muscle; usually causes pain that worsens with breathing and lying down.
Lung-Related Causes
Pulmonary embolism: Sudden blockage in the lung vessel by a clot, characterized by severe shortness of breath and pain.
Pleurisy (inflammation of the lung membrane): Causes sharp pain that increases with breathing or coughing.
Pneumothorax: Collapse of the lung due to air leakage from the lungs; causes sudden and intense pain along with breathing difficulty.
Pneumonia: Lung inflammation; may present with fever, cough, and chest pain.
Bronchitis, asthma, and COPD: Chest pain and shortness of breath resulting from narrowing or inflammation of the airways.
Digestive System-Related Causes
Reflux (Gastroesophageal reflux): Burning chest pain may be felt due to stomach acid escaping into the esophagus, sometimes accompanied by bitter water coming up to the mouth.
Esophageal disorders: Difficulty swallowing or muscle spasms can cause chest pain.
Gallbladder and pancreas diseases: Gallstones or pancreatitis may sometimes cause pain radiating to the chest.
Musculoskeletal System-Related Causes
Costochondritis: Inflammation of the cartilage connecting the breastbone and ribs is commonly seen in pain.
Muscle pain and fibromyalgia: Especially seen in recurrent or chronic muscle pain.
Rib injuries: Cracked or broken ribs may cause pain that increases with touch or movement.
Psychological and Other Causes
Panic attack: Anxiety may be felt along with rapid heartbeat, sweating, dizziness, and intense chest pain.
Shingles: Painful rashes may develop on the trunk and chest area due to reactivation of the chickenpox virus.
Other: Severe cough, prolonged respiratory distress, and even certain breathing disorders can also cause chest pain.
Symptoms That May Accompany Chest Pain
The following symptoms accompanying pain may require urgent evaluation:
Feeling of pressure, fullness, or burning in the chest,
Pain radiating to the back, neck, jaw, or arms,
Pain that is prolonged, does not subside with rest, and worsens with activity,
Shortness of breath,
Cold sweating,
Dizziness or feeling faint,
Nausea or vomiting,
General weakness and palpitations.
The following situations may indicate non-cardiac causes:
Pain that develops only after eating,
Bitter or sour water coming up to the mouth,
Accompanying difficulty swallowing,
Pain that changes with body position or deep breathing,
Rash, fever, or chills on the skin,
Severe cough.
How Is Chest Pain Evaluated?
Doctors start with a detailed patient history and physical examination to find the source of chest pain. Frequently asked questions include:
When and how did the pain start?
Is the pain constant or intermittent?
Are there any factors such as movement, eating, or exposure to stress that affect it?
Does the pain radiate to another area?
Has a similar situation occurred in the past?
The main tests used when necessary are:
Electrocardiogram (ECG): Heart rhythm and possible muscle damage are evaluated.
Blood tests: Indicators of heart muscle damage (such as troponin) are examined.
Chest X-ray: The general condition of the heart and lungs is checked.
Computed tomography (CT): Serious conditions such as pulmonary embolism or aortic dissection are investigated.
Information About “Common Cold” and Stomach Cold (Stomach Flu) Other Than Chest Pain
The common cold and stomach cold can cause symptoms that may be confused with chest pain. Both usually occur due to viruses.
Symptoms of the Common Cold (Nasopharyngitis)
Nasal congestion or runny nose,
Sore throat,
Cough,
Widespread body aches and headache,
Mild fever,
Sneezing and fatigue.
Symptoms may vary from person to person and are usually mild. Medical evaluation is required in cases such as severe or prolonged fever, shortness of breath, or severe fatigue.
Symptoms of Stomach Cold (Viral Gastroenteritis)
Watery diarrhea,
Abdominal pain and cramps,
Nausea and vomiting,
Muscle aches and headache,
Mild fever.
Most of the time it resolves within a few days; however, findings such as high fever, severe fluid loss, bloody stool, or persistent vomiting require a doctor's evaluation.
Causes of the Common Cold and Ways to Prevent It
The common cold is usually caused by rhinoviruses, while stomach cold is caused by viruses such as norovirus and rotavirus. The diseases can be transmitted through coughing, sneezing, close contact, or contaminated objects.
To protect yourself:
Wash your hands regularly with soap,
Avoid contact with sick people,
Wash food thoroughly and follow hygiene rules,
Avoid sharing personal items.
Treatment and Supportive Approaches
Both the common cold and stomach cold are viral in origin, so antibiotics are not effective. Measures are generally taken to alleviate symptoms:
For the common cold:
Drink plenty of fluids,
Prefer hot drinks such as soup,
Rest,
Support sore throat by gargling with salt water.
For stomach cold:
Take a break from eating, drink plenty of fluids,
Prefer easily digestible foods,
Get plenty of rest,
Do not use anti-diarrheal medications in children without a doctor's advice.
When Should You Go to the Emergency Room for Chest Pain?
You should go to the emergency department without delay in the following situations:
Chest pain is sudden, severe, and does not subside with rest,
Pain is accompanied by shortness of breath, palpitations, sweating, nausea, or dizziness,
Pain radiates to the back, neck, or arms,
If you have a known heart or lung disease and your complaints have increased.
Frequently Asked Questions
1. Is chest pain always a sign of a heart attack?
No, chest pain can be caused by different reasons. However, especially sudden, severe, or prolonged pain
the possibility of a heart attack should be ruled out.2. Can the common cold cause chest pain?
Rarely, mild chest pain may be felt due to cough and muscle aches accompanying upper respiratory tract infections.
3. Can stomach flu cause chest pain?
In some individuals, severe stomach cramps or reflux may cause discomfort in the chest.
4. When should I go to the emergency room?
Sudden onset pain that does not subside with rest, or findings such as difficulty breathing, sweating, or pain radiating to the arms require urgent medical attention.
5. What causes muscle pain in the chest?
Heavy exercise, poor posture, or muscle injuries can often cause muscle-related chest pain; however, if the pain is severe, persistent, or accompanied by other symptoms, a doctor's evaluation is necessary.
6. Can Covid-19 cause chest pain?
Yes, especially in severe respiratory tract infections or lung involvement, chest pain may be felt. In such cases, medical support should be sought promptly.
7. Can chest pain be related to the digestive system?
Yes. Especially the backflow of stomach acid into the esophagus (reflux) and esophageal diseases can cause chest pain after eating.
8. Is chest pain in children serious?
In most cases in children, it is not serious, but in cases of persistent or severe pain, a doctor should be consulted.
9. What can be done at home for muscle pain in the chest?
Rest, light exercise, warm applications, and simple painkillers if necessary may be helpful. In case of doubt, a doctor's advice should be sought.
10. What should be considered until stomach flu passes?
It is beneficial to take adequate fluids, eat light foods, and rest. If there are severe symptoms, consult a doctor.
11. What diseases should be considered when chest and back pain occur together?
Cardiovascular diseases, musculoskeletal problems, or spinal or disc disorders may be causes of combined pain.
12. What does pain under the right chest indicate?
It may originate from the liver, gallbladder, lung, or musculoskeletal system; examination is necessary in cases of severe or prolonged pain.
13. Is nipple pain significant?
In some cases, it may be related to hormonal changes or simple causes, but if the pain is persistent and does not go away, a doctor's check-up is necessary.
14. Can chest pain have psychological causes?
Yes. Anxiety disorders and panic attacks can cause chest pain; this diagnosis is often made after other physical causes are ruled out.
15. What can be done to prevent chest pain?
Protecting heart and lung health, exercising regularly, and keeping chronic diseases under control help reduce the risk of chest pain.
References
World Health Organization (WHO), Chest pain: assessment and management
American Heart Association (AHA), Warning Signs of a Heart Attack
American Lung Association (ALA), Classification and Causes of Chest Pain
Centers for Disease Control and Prevention (CDC), Common Colds and Acute Respiratory Tract Infections
Mayo Clinic, Chest pain: First aid
European Society of Cardiology (ESC), Cardiac causes of chest pain
UpToDate, Initial evaluation of the adult patient with chest pain in the emergency department