Chest Pain 101
BY: Michael Castleman
You have a pain in your chest. It’s different from anything you’ve ever experienced before. If you’re like most people, the first thought that crosses your mind is: Is it a heart attack? Play it safe. Call 911. You might need emergency attention. But once you’ve been checked out, chances are you’ll be told it wasn’t “the big one.” In fact, a team of 59 Swiss physicians recently analyzed 24,620 people who consulted doctors for new chest pain. More than 40 ailments were diagnosed -- and only 16 percent involved heart disease. The leading diagnosis (49 percent) was musculoskeletal injury, such as muscle strain. Other common causes included anxiety (11 percent) and heartburn (8 percent). Here’s how to tell them apart:
Heart attack While heart attack symptoms can vary, the classic signs include pressing or squeezing chest pain; pain in the neck, jaw, back or arm; shortness of breath, nausea, lightheadedness and/or a cold sweat. In men, chest pain typically predominates. In women, non-chest symptoms may be more prominent. Keep in mind that chest pain is more likely to be a heart attack if you’re a man over 40 or a woman over 50 and you smoke, are overweight or have diabetes, high cholesterol, high blood pressure or a family history of heart disease.
Since heart attacks are deadly, don’t mess around. If you have any suspicions that you might be having one, call 911, says American Heart Association spokesperson Nick Bhatt. Ask the operator if you should take aspirin, which may open deadly blockages in the heart’s arteries. If the operator says yes, make sure you really take aspirin -- not ibuprofen (e.g., Motrin, Advil) or acetaminophen (e.g., Tylenol). Then either wait for paramedics or have someone take you to an emergency room as quickly as possible.
Angina causes chest pain on exertion. You might feel fine walking, but running to catch a bus might cause chest pain. Angina is a form of heart disease. It develops when an artery in the heart becomes severely narrowed. When this happens, that part of the heart gets less oxygen and nourishment, resulting in pain (and if the artery becomes completely blocked, the result is a heart attack). Angina pain typically subsides with rest. If you suspect angina, see your doctor promptly.
Musculoskeletal injury Muscle strains and rib injuries can cause severe chest pain. Rib injuries typically result from trauma, like getting hit in the chest, but muscle strain may occur for no apparent reason, especially in older folks, because muscles become more fragile with age. If you’ve pulled a muscle or knocked your ribs around, ice the affected area and take an over-the-counter pain reliever, such as aspirin, ibuprofen or acetaminophen. Consult a doctor if the pain gets worse or does not improve significantly in a week.
Anxiety can cause many symptoms: stomachache, headache and -- quite often -- chest pain. Add a racing heartbeat, sweating and hyperventilation -- all symptoms of a panic attack -- and it could very well feel like you’re having a heart attack. If you have any doubt, call 911. If it turns out your symptoms are due to anxiety, a variety of treatment options are available. British researchers have identified several nondrug approaches that can help, including psychotherapy, cognitive-behavioral therapy and hypnotherapy. Your doctor may also prescribe antianxiety medication or suggest relaxation techniques, such as meditation, yoga, tai chi or even plain and simple exercise, like walking.
Heartburn Commercials call it acid indigestion. If it occurs frequently, doctors call it GERD (gastro-esophageal reflux disease). Whatever you call it, heartburn is very common. Some 60 million Americans experience heartburn at least once a month. It’s caused by a malfunction of the valve that connects your stomach to your esophagus (the “food tube” that runs from your mouth to your belly). Jeffrey Goldman, M.D., a gastroenterologist at Resurrection Medical Center in Chicago explains that when you eat, this valve opens so that food traveling down your esophagus can enter into your stomach. Then it’s supposed to close tightly, keeping stomach acids from backing up into the esophagus. But if the valve malfunctions and opens, searing acids splash up into the esophagus, resulting in burning chest pain that can sometimes feel like a heart attack.
Heartburn typically strikes after meals. You are more likely to experience heartburn if you eat fatty foods or large meals; eat too quickly or shortly before lying down (such as before bed), wear tight clothing around your waist, are obese or under stress, or smoke. Eliminating these risk factors often cures heartburn. If not, your doctor may recommend medication.
Okay, so that pain in your chest probably isn’t a heart attack. But call 911 or your doctor just to be sure. If it turns out it is your ticker, it could save your life. And if it’s something else, you will find out what’s really ailing you so you can get proper treatment and feel better faster.
Michael Castleman has been called "one of the nation's leading health writers" (Library Journal). He is the author of 11 consumer health books and more than 1,500 health articles for magazines and the Web. Michael is a frequent contributor to Live Right Live Well.