Chest pain

Every fifth person who goes to the emergency room does so due to chest pain. Only half of those are due to cardiovascular problems.
Thus, more than 50 percent of acute chest pain is related to something other than the heart. Anxiety and stress-related disorders are common explanations as well as other factors that cause pain and tension in the muscles around the heart.

Since many symptoms can easily be mistaken for myocardial infarction, it is important to always seek medical advice if you have doubts about what is causing your chest pain.

There are many causes of chest pain which range from transient and harmless to severe conditions requiring emergency care.

Different explanations for chest pain:

• Cardiovascular Diseases
  One or more of the heart’s coronary arteries become constricted or clogged completely so that the blood cannot pass to the heart. High blood pressure and atherosclerosis increase the risk of both stroke and heart attack. In myocarditis, you may have chest pain and elevated heart rate, which can also be similar to the symptoms of myocardial infarction.
• Stress and anxiety
  Mental stress can lead to tense and sore muscles in the chest, particularly during anxiety or panic attacks. Then it may seem that the pain comes from the heart itself. Muscle pain can be difficult to distinguish from myocardial infarction, because you can also experience an elevated heart rate, respiratory problems and sweating.
• Muscle aches
  Tensions and exercise pains can sometimes occur in the chest, for example in the case of chest inflammation, but then the pain comes from the muscles and not from the heart. In conjunction with herniated discs, the muscles in the chest can also be affected and cause persistent pain that sometimes radiates to the arms. Still, it can be difficult to distinguish the pain from myocardial infarction.
• Lung diseases
  Pleuritis, pneumonia, pulmonary embolism and bronchitis can all cause chest pain, often with respiratory distress. Then the pain manifests either in the lungs or in the muscles, but can be difficult to distinguish from severe cardiovascular disease. Asthma and COPD can cause respiratory distress and chest pressure.
• Gastrointestinal system
  Gastritis and stomach ulcers usually cause pain in the upper abdomen, sometimes up to the chest, while gallstones can cause intense pain at intervals high up on the right side of the stomach behind the ribs.

Chest pain can be felt in many different ways. Symptoms vary from palpitations and difficulty breathing to chest pressure, chest cramping or acute pain. You can also get a high heart rate and blood pressure.

Acute myocardial infarction is usually characterized by sudden chest pain that lasts for more than 15 minutes. The pain can also spread to the left arm, shoulders or neck. Shortness of breath, nausea, sweating and dizziness are common. 

A heart attack can also start without symptoms, (so-called silent heart attack), which are especially common in women.

Vascular spasms give similar symptoms to heart attacks and often appear in association with physical exertion or mental stress. 

In lung diseases, such as blood clots in the lung or pneumonia, you may also have breathing problems and chest pain, sometimes with a fever.

Bear in mind that chest pain does not always have to be a sign of a serious illness. It can be difficult to determine where the pain comes from – sometimes it is a problem with the gastrointestinal system or a muscle pain in the chest. It may feel uncomfortable, but is rarely dangerous.

Chest pain can be prevented if the risks factors are avoided or minimized:

• Quit smoking and drinking alcohol.
• Carry out physical activity within your range, such as a daily walk of at least 30 minutes.
• Follow a balanced and varied diet.
• Avoid consuming saturated fats (red meat like lamb and beef, fried foods, pastries and cakes).
• Eat foods rich in omega-3 for their cardioprotector effect, such as dried fruits, and blue fish, like salmon, sardines, white anchovies, tuna (fresh, frozen, canned).
• Reduce the consumption of salt.

The treatment depends entirely on what causes your chest pain.

A doctor will look at your symptoms, information about your life situation and past illnesses, to correctly diagnose you and provide the right treatment. ECG (electrocardiogram), blood pressure and blood tests, as well as possibly X-rays and ultrasounds, will be taken to complete the picture.

Treatment can include anything from changing your diet, creating more balance in everyday life and taking part in physiotherapy, to drugs and emergency medical care, sometimes with physical interventions.

If you believe that there is the slightest risk that your chest pain may be due to a heart attack, you should contact an emergency room.
If you have chest pain and suspect that the pain is stress-related, lifestyle changes can reduce your problems. It may also be helpful to contact a psychologist to find ways to relieve anxiety, for example through Cognitive Behavioral Therapy (CBT).

In the case of overworked muscles, non-prescription pain medication can relieve the pain; a physiotherapist can also help you with exercises that relax muscles.

If you have chest pains that you do not recognize or if you feel anxious, you should get medical help.

If you think you have a heart attack, feel acute chest pain, pressure or spasmodic pain or an unpleasant chest feeling that lasts longer than 15 minutes, you should contact an emergency room. If you have chest pain together with shortness of breath, nausea, cold sweats or irregular heartbeats, you should also call an ambulance.

In case of sudden or persistent chest pain, seek emergency care. If these are minor issues, APPOTEK can help you. A nurse or a physician will make an individual assessment based on your symptoms, after which you may be prescribed treatment or referred to a specialist. If your complaints are stress-related, you can also talk to one of our psychologists.

For chest pain, a physical examination is often required.