Angina (cont.)
What are other causes of chest pain?
In caring for patients with chest pain, the doctor
distinguishes whether
the pain is related to a lack of oxygen to the heart muscle (as
in angina
or heart attack), or is due to another process. Many conditions
are
considered that can cause chest pain which is similar to that
of a heart
attack or angina. Examples include the following:
- Pleuritis (pleurisy): Inflammation of the lining of the lungs (pleuritis) causes sharp chest pain, which is aggravated by deep breathing and
coughing. Patients often notice shortness of breath, in part due to their shallow breathing to minimize chest pain. Viral infections are the most common causes of pleurisy. Other systemic inflammatory conditions, such as systemic lupus, can also cause pleurisy.
- Pericarditis: Pericarditis is inflammation of the lining around the heart. Symptoms of pericarditis are similar to that of pleuritis.
- Pneumonia: Pneumonia (bacterial infection of the lung) causes fever and chest pain. Chest pain in bacterial pneumonia is due to an irritation or infection of the lining of the lung (pleura).
- Pulmonary embolism: blood clots travel from the veins of the pelvis or the lower extremities to the lung, the condition is called
pulmonary embolism. Pulmonary embolism can cause death of lung tissue (pulmonary infarction). Pulmonary infarction can lead to irritation of the pleura, causing chest pain similar to pleurisy. Some common causes of blood clots in these veins
is deep vein thrombosis
(prolonged immobility, recent surgery, trauma to the legs, or pelvic infection).
- Pneumothorax: Small sacs in the lung tissue (alveoli) can spontaneously burst, causing
pneumothorax. Symptoms of pneumothorax include sudden, severe, sharp chest pain and shortness of breath. One common cause of pneumothorax is severe emphysema.
- Mitral valve prolapse:
Mitral valve prolapse is a common heart valve abnormality, affecting 5%
to 10% of the population. MVP is especially common among women between 20 to 40 years of age. Chest pain with MVP is usually sharp
but not severe. Unlike angina, chest pain with MVP rarely occurs during or after exercise, and usually will not respond to nitroglycerin.
- Aortic dissection:
The aorta is the major vessel delivering blood from the left ventricle to the rest of the body.
Aortic dissection (tearing of the aorta wall) is a life-threatening emergency. Aortic dissection causes severe, unrelenting chest and back pain. Young adults with aortic dissection usually have
Marfan's syndrome, an inherited disease in which an abnormal form of the structural protein called collagen causes weakness of the aortic wall. Older patients develop aortic dissection typically as a result of chronic, high blood pressure, in addition to generalized hardening of the arteries (arteriosclerosis).
- Costochondritis, rib fractures, muscle strain or spasm:
Pain originating from the chest wall may be due to
muscle strain or
spasm,
costochondritis, or
rib fractures. Chest wall pain is usually sharp and constant. It is usually worsened by movement, coughing, deep breathing, and direct pressure on the area. Muscle spasm and strain can result from vigorous, unusual twisting and bending. The joints between the ribs and cartilage next to the breastbone can become inflamed, a condition called costochondritis. Fractured ribs resulting from trauma or cancer involvement can cause significant chest pain.
- Nerve compression:
Compression of the nerve
roots by bone spurs as they exit the spinal cord can cause pain.
Nerve compression can also cause weakness and numbness in the upper arm
and chest.
- Shingles (herpes zoster infection of the nerves):
Shingles is nerve
irritation from the infection, which can cause chest pain days before
any typical rash appears.
- Esophageal spasm and reflux:
The esophagus is the long muscular tube connecting the mouth to the stomach.
Reflux, or regurgitation of stomach contents and acid into the esophagus can cause heartburn and chest pain. Spasm of the muscle of the esophagus can also cause chest pain which can be indistinguishable from chest pain caused by angina or a heart attack. The cause of esophageal muscle spasm is not known. Pain of esophageal spasm can respond to nitroglycerin in a similar manner as angina.
- Gallbladder attack (gallstones):
Gallstones can block the gallbladder or bile ducts and cause severe pain of the upper abdomen, back and chest. Gallbladder attacks can mimic the pain of angina and heart attack.
- Anxiety and panic attacks:
Anxiety, depression, and
panic attacks are frequently associated with chest pain
lasting from minutes to days. The pain can be sharp or dull. It is usually
accompanied by shortness of breath, or the inability to take a deep breath.
Emotional stress can aggravate chest pain, but the pain is generally not related
to exertion, and is not relieved by nitroglycerin. These patients often breath
too fast (hyperventilate), causing lightheadedness, numbness, and tingling in the lips and fingers. Coronary artery disease risk factors are typically absent in these patients. Since there is no test for panic attacks, patients with chest pain usually undergo tests to exclude coronary artery disease and other causes of chest pain.
For more, please read the
Chest Pain article.
Next: Why is it important to establish the diagnosis of angina? »
- Beta Blockers - Learn more about Beta Blockers, a drug that treats angina and other heart rhythm disorders, migraines, high blood pressure, panic attacks, and tremors. Generic and brand names are included in the article.
- Coronary Artery Bypass Graft - Read about heart bypass surgery (coronary artery bypass graft surgery, CABG) including how coronary artery disease is diagnosed, treated, recovery time, risks and complications, and the long term results after CABG.
- Low Blood Pressure - Learn about low blood pressure (hypotension). Low blood pressure is blood pressure below normal and symptoms may include: lightheadedness, dizziness, fainting upon standing (orthostatic hypotension). There are many causes of low blood pressure, and treatment is dependant upon the cause.
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