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"CHEST PAIN"

 

     Chest pain has many causes.  If you are under 30 and have sharp, stabbing pains that last a second or two and come and go, you likely have gas or some other harmless cause.  Pain that persists in the chest in young people who do not smoke or use cocaine could be one of several things as follows below. 

     Trauma is the number one cause of chest pain in younger adult patients.  A broken rib would cause severe pain and needs medical attention.  Unfortunately, that will require a chest x-ray. 

     If you have worse pain when you breathe in, you could have pleurisy, an inflammation of the lining of your lungs.  Pleurisy is usually caused by a virus but could be caused by autoimmune diseases like rheumatoid arthritis or Lupus. 

      If you are young and have a fever and cough with chest pain, you might have pneumonia.    

A collapsed lung, called a pneumothorax, can cause sharp chest pain, but the pain usually lasts longer and commonly is associated with shortness of breath or some kind of trauma.  Spontaneous collapsing of the lung can often run in families. 

     Costochondritis (also known as Tietz’s Syndrome), which is inflammation where the ribs insert into your sternum, can cause chest pain in young and older patients alike.  This condition is marked by the pain being worse were you to press on the area, or worse when you take a deep breath. 

     Inflammation of the sack your heart sits in to reduce friction as it squeezes is called pericarditis and causes sharp pain that is worse when you lie on your back and usually is better leaning forward.  Go to the emergency room or your doctor if that is the case.  Pericarditis has many causes including autoimmune, viruses and thyroid and kidney disease. 

     Blood clots flying to your lungs from your legs can cause chest pain.  These usually occur in families or follow a long car ride or air travel.  There may or may not be swelling in the legs with this.  This condition is called Pulmonary Embolus.  A key to this disorder is that the chest pain is usually on one side or the other and is often accompanied with shortness of breath or dizziness with a fast heart rate.  Go to the E.R. if you think you have a pulmonary embolus. 

     Pleurisy, which is chest pain caused by inflammation of the lining of your lungs is addressed with the older folks below, but it occurs in young people, too. 

     Anxiety and Panic attacks can cause chest pain.  If you have anxiety, you likely know that already. 

     Older patients with chest pain and those who smoke are more complicated.  We will address these now.  

     If you are older, have COPD or Asthma or smoke and have chest pain upon breathing in and out, it is probably worsening of the above that is the cause.  If the pain is “pressing or heavy” and comes at rest but worse with walking, then think “heart-cause”.  This means you have to see a doctor quickly, because you likely have more than one disease.   

      If you have known heart disease and have chest pain that lasts more than a minute, especially if dull or radiates to shoulder, jaw, arm or back, seek medical help quickly. 

     Older patients with longstanding high blood pressure can develop an aortic dissection or aneurysm that can cause terrible pain that usually radiates to the back.  If this happens to you, go to the E.R. or call 911.  

     Exertional chest pain that goes away with rest in patients who have risk factors for heart disease such as cigarette smoking, high blood pressure, high cholesterol, a family history of heart disease, and/or diabetes is usually heart-related.  If that is you, see your doctor. 

     Chest pain can result from gallstones.  Even though your gallbladder is in your stomach area, the gallbladder pain can radiate up to the chest.  This is called referred pain.  Gallstones are more common in women, 40 and over and who are over-weight, but anyone can have them.

      Acid reflux can cause chest pain, as can stomach ulcers.  This cause of pain does not get worse with activity and is often relieved with anti-acid medications.  Hiatal hernias can cause chest pain.  This is where a portion of the stomach slides up and down through the diaphragm. 

     If you are a smoker and are older and have been smoking for years and have a dull aching chest pain that has persisted, you could have lung cancer.  We suggest you see your doctor. 

      If you have chest pain and cough up blood, go directly to the E.R. or call 911.                                                                                                

     Chest pain can also come from irregular heart rhythms where the heart is going too fast.  The most common types of abnormal heart rhythms are atrial flutter and atrial fibrillation.  These dysrhythmias can cause the heart to beat entirely too fast and become inefficient, resulting in chest pain and shortness of breath.  Diagnosing this might require wearing of a heart monitor called an Event or Holter Monitor which records the heart rhythm. 

     Another cause of chest pain to be considered is Sarcoidosis.   Sarcoidosis is a non-caseating granulomatous disease that few people fully understand.  This causes enlargement of the lymph nodes around the heart, in the mediastinum, which is basically the center of your chest.  Sarcoidosis can be diagnosed by chest x-ray and by biopsy of lesions that typically appear on the skin, but they are not always present.  Sarcoid is more common in black females, but it can affect anyone.  For some reason, many patients with sarcoid tend to get Raynaud’s phenomenon, which is blanching of the fingers when exposed to cold temperatures, followed by red fingers that hurt when the blood flow resumes.

      Pleurisy is another cause of chest pain.  Pleurisy is inflammation of the lining of the lungs, very similar to pericarditis.  This type of chest pain is usually caused by a virus or an infection of some sort and is worse with deep breathing.  It is sometimes accompanied by a cough.  A chest x-ray may or may not reveal this.  Pleurisy can accompany pneumonia. 

     Excessive coughing can lead to chest pain, whether it is caused by pneumonia, bronchitis, or COPD. 

      Another and much less frequent cause of chest pain could be primary lung cancer or metastatic cancer to the lung or ribcage area.  Please remember that if you have chest pain, it is very unlikely you have lung cancer or other cancer that traveled to the lungs or ribs called metastatic cancer.  However, if you are older and had cancer elsewhere, it might require a CT scan or more aggressive evaluation.      

     Although there are other less common causes of chest pain, the ones outlined are the most important in our estimation.  Understand that the diagnosis of chest pain and narrowing down the actual cause is difficult and requires a sequential and logical thought process, along with well-thought out testing.   

     We hope you have found this information useful.  It is our intent to keep you well-informed and to avoid a catastrophic event while not making you worry too much.  Thank you for your time and interest at MDeduONLINE.com and the MDedu. App.