Chest pain or thoracic pain called in medical jargon is one of the most frequent symptoms evaluated in cardiology consultations.
There are numerous causes of it, which are listed below from most to least serious.
First, it can be of cardiac origin (heart attack, pericarditis or inflammation of the sac surrounding the heart, heart valve dysfunction, cardiomyopathies, aortic pathology, etc.). It can also be of pulmonary origin , as in cases of pneumonia, pulmonary thromboembolism, pneumothorax, lung parenchymal diseases, or bronchospasm. It is also not uncommon for digestive diseases to cause chest pain (stomach ulcers, gastroesophageal reflux or "heartburn," esophageal spasms, etc.).
Finally, we can find causes that are not very important but are frequent in clinical practice, such as those of musculoskeletal origin or states of anxiety.
Depending on the characteristics of the symptom, in general the causes we have just discussed can be oriented (although this is not possible in all cases).
In this way, pain of cardiological origin (such as angina) is usually in the center of the chest, oppressive (“like a weight or a stone”), and can radiate or move to both arms, the back or the throat. and is typically triggered by effort and subsides or decreases in intensity with rest.
Those of pulmonary origin usually have pleuritic characteristics, that is, they increase with respiratory movements (deep inspiration or expiration) and are sometimes also associated with self-hearing of wheeze.
On the other hand, digestive pains tend to be lower in the thorax (in the stomach) and can move towards the throat with an ascending origin (such as those caused by reflux or ulcers). However, esophageal spasm can sometimes be indistinguishable from myocardial infarction.
Musculoskeletal pain, on the other hand, is usually limited to a small part of the chest (which can sometimes be delimited by the tip of a finger) and usually changes or worsens with chest movements.
Finally, anxiety can present a mixture of the characteristics described above, although the patient usually reports a significant preceding state of nervousness.
Because the origin of chest pain can be very diverse and some causes of it can be serious, from the cardiology consultation we usually request complementary tests that, although in many cases they do not allow us to know what the cause of the pain is, they do. They allow us to rule out those that may generally be important from a cardiological point of view.
First, we usually perform an electrocardiogram and echocardiogram , which give us an initial idea of whether the patient's heart is structurally normal or healthy.
Subsequently, a stress test is usually ordered , which consists of walking or running on a treadmill with blood pressure monitored and an electrocardiogram (ECG) taken, allowing us to see the heart's response to exertion in real time. This is very useful for ruling out ischemic heart disease or exertional angina. When the ECG is abnormal or we suspect a cardiac origin of the chest pain, we usually supplement the study with a coronary CT scan (to non-invasively visualize the arteries of the heart using tomography) or coronary angiography (visualizing the arteries of the heart through a catheter inserted through the patient's radial artery).
Other times we can expand the study with Holter-ECG or Holter-BP (continuous monitoring for 24 hours with electrocardiogram or blood pressure measuring device), depending on the clinical suspicion or associated symptoms.
If our study is normal, in many cases the patient is referred to other specialists (pulmonologists, digestive, primary care, psychology) who perform the relevant tests.
Therefore, chest pain is a very common symptom, which most of the time will not have a relevant cause, but which is important to study, since a small percentage of cases may be serious illnesses that need to be treated. address as soon as possible.
By Dr. Irene Narváez, Cardiology Specialist at UICAR