There are numerous causes for chest pain and although some of them may relate to the heart, and should be treated as an emergency, may are related to pathologies totally unrelated to the heart. So, how do you differentiate between the many causes of chest pain?
The easiest way to differentiate between types of chest pains is to assess the pain based on OPQRST questioning. The following are a list of common causes of chest pains and how to differentiate between them and cardiac chest pain. If in doubt, always treat chest pain as though it is cardiac in nature.
Chest Pain Causes
Myocardial Infarction – Onset: sudden. Provocation: occurrence at rest, with exertion, physical or emotional stress. Quality and intensity: severe pressure to the chest area ‘tightness,’ ‘crushing,’ ‘vice like,’ ‘heaviness.’ Region: Sub sternal, midline or anterior chest pain, radiating down left arm, jaw, fingers and abdomen. Severity and Signs and symptoms: dyspnoea, apprehension, nausea, diaphoresis, changes to pulse rate, decrease in blood pressure, gallop heart sounds. Often considered severe. Times: usually ½ an hour to 3 hours.
Angina – Onset: gradual or sudden onset. Provocation: Exertion, stress, micturition or defecation, cold or hot weather. Quality: Mild to moderate. ‘Stabbing,’ ‘heaviness,’ ‘tightness’ or ‘discomfort.’ Severity and Sign and Symptoms: dyspnoea, nausea, desire to void, belching, apprehension. Time: should self-resolve after rest within 30 minutes.
Pericarditis – Onset: sudden onset, continuous pain. Provocation: recent myocardial infarction, upper respiratory infection, no correlation to exertion. Quality: Mild ache to severe pain. Often more specific than a myocardial infarction, such as: ‘stabbing pain to specific point in chest’ and ‘knife life pain.’ Region: substernal pain to left or midline some radiating pain to back and sub-clavicular area. Severity and Signs and Symptoms: Precordial friction rub, increased pain with movement, inspiration, laughing, coughing, left sided pain, pain sometimes decreases by sitting or leaning forward.
Gastro-Oesophageal Reflux Disorder (GORD) – Onset: gradual, sudden, intermittent, or continuous pain. Provocation: ingestion of spicy foods, alcohol, soft drink. Quality: Squeezing pain and heartburn sensation. Region: sub sternal, midline or anterior/posterior chest pain. May have radiating pain to upper abdomen, back or shoulder tips. Severity and Signs and Symptoms: Dysphagia, belching, diaphoresis, vomiting, nausea, dysphagia, may decease with sitting or standing. Time: Often after eating.
Pleurisy – Onset: gradual or sudden onset. Provocation: Pneumonia, long term respiratory disorders, such as emphysema, COPD or severe asthma, respiratory infections. Quality: very specific pain, described as ‘knife like’ or ‘pin-point pain.’ Severity and Signs and Symptoms: Pleural friction rub, fever, dyspnoea, cough, pain on inspiration/expiration. Time: continuous.
Musculo-skeletal: Onset: gradual or sudden onset. Provocation: weight lifting and excessive exertion to the pectoral muscles, abdominal muscles, and back muscles. Quality: Soreness and muscular tenderness. This may mimic the heaviness associated with an Acute Coronary Syndrome. Severity and Signs and Symptoms: Severe pain, increased on movement. No changes to perfusion, such as diaphoresis or skin perfusion. Times: intermittent pain for 2-3 days.
Tietze’s Syndrome: Onset: gradual or sudden onset. Provocation: Common after upper respiratory infection and cool weather. Quality: mild to severe tenderness. Region: anterior chest articulations; radiation to either shoulder or arm.
Costochondritis: Onset: gradual or sudden. Provocation: common after a long term chest infection, or strenuous exertion involving the muscles of the chest wall. Quality: ‘Sharp’ or ‘crushing’ in nature. Region: retrosternal, left and right arm, sternal. Severity: 10/10 intense pain. Time: intermittent or acute.
Anxiety: stress can trigger the sympathetic nervous system’s ‘fight or flight’ response and this can mimick many of the signs and symptoms associated with an acute coronary syndrome. The easiest way to differentiate between these two causes of chest pain, is to determine what the stress is and see if the removal of such a stress relieves the chest pain. In many cases, these patient’s will have to be treated as though they are having an acute coronary syndrome first and then later have the stress managed.
Chest pains can indicate a life threatening cardiac condition, such as a ‘heart attack’ and medical assessment and treatment should never be delayed. Until the chest pains are proven to be caused by something other than than the heart, I recommend calling an Ambulance immediately when you get chest pains and go straight to an emergency department. If chest pains are caused by damage to your heart, the earlier you get treatment the better your heart will be.
The problem with waiting when you have chest pains is that if it is caused by damage to the heart, every minute that you don’t receive treatment will cause more myocardial (heart) cells to die. Once enough of your heart cells die, there is nothing you can do to fix your heart. So, with chest pains, act fast and call an Ambulance now!
For information about chest pain and heart attacks please visit the Chest Pain page.