Chest Pain
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Daniel
Kulick, MD, FACC, FSCAI and Melissa Conrad Stöppler, MD
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Heart Attack Symptoms and Early Warning Signs
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Dennis Lee, MD
 Heart
attack is the number one killer of both men and
women in the U.S. Each year, about 1.1 million Americans suffer a heart attack,
and 460,000 of these are fatal. Most of the deaths from heart attacks are caused
by ventricular fibrillation of the heart that occurs before the victim of the
heart attack can reach an emergency room. Those who reach the emergency room
have an excellent prognosis; survival from a heart attack with modern treatment should exceed 90%.
The 1% to 10% of heart attack victims who die later include those victims who
suffer major damage to the heart muscle initially
or who suffer additional damage at a later time.
Fortunately, procedures such as
coronary angiogram and
PTCA (coronary balloon
angioplasty), and clot dissolving drugs are available that can quickly open
blocked arteries in order to restore circulation to the heart and limit heart
muscle damage. In order to optimally benefit heart attack victims and limit the
extent of heart damage, these treatments to open blocked arteries should be
given early during a heart attack.
Knowing the early warning signs of heart attack...
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Introduction
Chest pain is one of the most common complaints that will bring a patient to
the Emergency Department. Seeking immediate care may be lifesaving, and
considerable public education has been undertaken to get patients to access
medical care when chest pain strikes. While the patient may be worried about a
heart attack, there are many other causes of pain in the chest that the healthcare provider will need to consider. Some diagnoses are life threatening, while
others are less dangerous.
Deciding the cause of chest pain is sometimes very difficult and may require
blood tests, x-rays, CT scans and
other tests to sort out the diagnosis. Often though,
a careful history taken by the healthcare provider may be all that is needed to find
the answer.
What are the sources of chest pain?
The source of pain may arise from a variety of potential sources:
- the chest wall including the ribs, the muscles, and the skin;
- the back including the spine, the nerves, and the back muscles;
- the lung, the pleura (the lining of the lung) or the trachea;
- the heart including the pericardium (the sac that surrounds the heart);
- the aorta;
- the esophagus;
- the diaphragm, the flat muscle that separates the chest and abdominal
cavities;
- referred pain from abdominal organs like the stomach, gallbladder, and
pancreas.
While each source of chest pain may have a classic presentation of signs and
symptoms, there is significant overlap among the symptoms of each condition, and
the symptoms may also be affected by age, gender and race.
What are the causes of chest pain?
Pain can be caused by almost every structure in the chest. Different organs
can produce different types of pain but unfortunately the pain is not specific
to each cause. Each of the following causes is explained in detail in this
article:
Next: How is chest pain diagnosed? »
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