Chest pain: How to understand chest pain and the possible reasons for it

Chest pain is typically considered a sign of a heart attack. For this reason, people often panic when they experience chest pain, fearing it is a heart-related complication. We spoke to dr. Bikky Chaurasia, Consultant Internal Medicine, Kokilaben Dhirubhai Ambani Hospital and Dr. Viveka Kumar, Principal Director and Chief of Cath Labs, Max Super Specialty Hospital, Saket to understand the signs and symptoms and rule out cardiac complications.
dr Viveka shares: “Acute chest pain is one of the most common reasons for seeking emergency department (ED) help, accounting for approximately 10% of all visits. Although chest pain increases the possibility of acute coronary syndrome (ACS), only 10% to 15% of patients with acute chest pain actually have ACS upon diagnostic evaluation.” Bikky adds: “Chest pain is typically associated with heart disease, but has typical features such as sweating, malaise, and palpitations, and radiates to the back, neck, arm, and jaw. Any type of chest pain is a medical emergency until detected. Chest pain shouldn’t be ignored, although it’s not always associated with a heart attack. That’s why it’s important to rule out whether it’s cardiac or non-cardiac so you can ask your doctor for help or rush to a nearby hospital.”

How to recognize chest pain that indicates a heart attack

Tests such as EKG, serial cardiac markers, 2D echocardiography, medical history, and clinical and vital signs are some of the ways doctors confirm heart problems.
“Chest pain associated with a heart attack is more likely to occur on the left side of the chest, is radiating in nature, and is moderate to severe in intensity and continuous. Other causes of chest pain can be either both sides or unilateral sides of the breast, but clinical and laboratory evaluation is always needed to rule out these things,” explains Dr. bikini.

Sharp or knife-edge pain caused by breathing movements or coughing, punctate and localized chest pain or mid- or lower-abdominal discomfort, pain reproduced by movement, constant pain lasting many hours, very brief episodes of pain lasting a few seconds or less, pain radiating to the lower extremities are some of the signs to look out for.

Silent and painless heart attacks

Silent or painless heart attacks occur in 20 to 25% of people. dr Pravin Kahale, Cardiology Specialist, Kokilaben Dhirubhai Ambani Hospital Mumbai, explains: “The most common people who experience this painless or silent heart attack, meaning very minimal symptoms, no typical chest pain, are diabetics and the elderly. However, it is also common in many individuals who have mild symptoms of a heart attack, such as dizziness, lightheadedness, nausea, and vomiting, and the episode resolves as mild acidity or mild dizziness. In fact, these patients are having silent heart attacks. Various series show that silent or painless heart attacks can occur in 20% to even 25% of people.”

Dizziness, fainting and fainting shortness of breath and hyperacidity. These are the usual copycats who, if not looked closely, would miss the diagnosis of a heart attack. The patient may not reach the hospital, and often even the ECG can miss 20-25% of the heart attack. Only when a blood troponin test is done can one find out about these missed heart attacks. Even the EKG can sometimes go undiagnosed, adds Dr. Pravin Kahale added.

Common reasons for chest pain

Pain in the side of the chest can most commonly occur due to pulmonary pathologies and musculoskeletal and neuropathic pain. It can also be due to pneumothorax, an infection of the lungs, which is a serious condition. Some common reasons are cardiac (myocardial infarction/angina, valvular heart disease/pericarditis), vascular (aortic dissection, pulmonary hypertension, and pulmonary embolism), pulmonary (pleuritis, pneumonia, pneumothorax, and tracheobronchitis), gastrointestinal (esophageal reflux, peptic ulcer disease, gallbladder). disease, inflammation of the pancreas), diseases of the musculoskeletal system (costochondritis, cervical spondylitis), infections such as herpes zoster or even psychological ones.