How does a doctor differentiate between types of chest pain?
The first thing the doctor evaluates is the nature of the pain. Compressive, pressing, diffuse pain behind the sternum, which appears with exertion and subsides with rest, is typical of angina. Acute pain, intensifying with inhalation and coughing, indicates pleura or lungs. Pain that can be caused by pressing a finger on a certain point or turning the body, usually muscle-costal. Burning after eating or while lying down is most often associated with the esophagus. The duration of the attack, what provokes it and what alleviates it are also important.
- Pressing, behind the sternum, with exertion - probable angina
- Acute, associated with breathing - pleura, lungs
- Point, with pressure and movement - muscles and ribs
- Burning after eating and lying down - esophagus and stomach
- Pain accompanied by anxiety, with rapid breathing - panic attack
Cardiac and vascular causes
This group includes angina pectoris and myocardial infarction, when the heart muscle lacks blood due to narrowing of the coronary arteries. This also includes pericarditis - inflammation of the heart sac, myocarditis, rhythm disturbances and sudden increases in blood pressure. Aortic dissection is a separate issue: very severe tearing pain that often radiates to the back; this condition is life-threatening. Such causes are the most dangerous, so they are excluded first, especially in people over 40 years of age and with risk factors.
- Angina pectoris
- Myocardial infarction
- Pericarditis and myocarditis
- Hypertensive crisis
- Heart rhythm disturbances
- Aortic dissection - requires emergency care
Non-cardiac causes
Most often, chest pain is not cardiac. Problems of the spine and ribs are common: osteochondrosis of the thoracic region, intercostal neuralgia, inflammation of the costal cartilages, muscle strain after physical work. The second large group is respiratory diseases: pneumonia, pleurisy, as well as pulmonary embolism and pneumothorax, which are dangerous and require urgent care. The third group is the esophagus and stomach: reflux disease, esophageal spasm, ulcer. Another common cause is anxiety disorder and panic attacks.
- Intercostal neuralgia and thoracic osteochondrosis
- Inflammation of the costal cartilages
- Pneumonia and pleurisy
- Pulmonary embolism, pneumothorax
- Gastroesophageal reflux disease and esophageal spasm
- Anxiety disorder and panic attacks
- Shingles before the rash appears
What examinations are needed
The examination begins with an ECG - it is advisable to take it in the first minutes of treatment. If a heart attack is suspected, a test for troponin, a marker of damage to the heart muscle, is done. An echocardiogram shows the functioning of the heart chambers and valves, and a chest x-ray reveals pneumonia, pleurisy, or pneumothorax. If the pain is associated with exercise, and the ECG at rest is normal, a stress test or 24-hour monitoring is prescribed. If an esophageal cause is suspected, a gastroscopy is performed; if a muscular cause is suspected, an examination and, if necessary, an x-ray of the spine are performed.
- ECG, repeat if necessary
- Troponin for suspected heart attack
- EchoCG
- Chest X-ray
- Treadmill test or Holter monitoring
- Gastroscopy for burning sensation and connection with food
- Lipid spectrum, glucose and blood pressure for risk assessment
What to do during an attack and how to treat it
If chest pain occurs for the first time, lasts longer than 15–20 minutes, or is accompanied by shortness of breath and sweating, you need to stop exertion, sit down, unfasten tight clothing and call 103. You cannot drive to the hospital on your own. Further treatment depends on the diagnosis: for coronary heart disease, these are drugs that reduce the load on the heart and cholesterol levels, sometimes stenting; for reflux - proton pump inhibitors and diet; for muscle pain - rest, warmth and pain relief. The doctor always selects the regimen.
- Stop the load and take a comfortable sitting position
- If severe pain occurs for the first time, call 103
- Do not drive by yourself
- Treatment depends on the identified cause
- Quitting smoking and controlling blood pressure, cholesterol, sugar
- Scheduled follow-up with a cardiologist for confirmed angina
