There are many different types of chest pain, it can be caused by many underlying conditions. Pinpointing the specific type of chest pain that you’re experiencing can help determine the cause. In this article, I will discuss the conditions that can cause different intensities of pain in the chest and give some treatment options and indicators of when you need to seek immediate medical attention.

What is Angina?

When the flow of blood toward the muscles of your heart is restricted, you may experience a type of chest pain known as angina. This commonly occurs when the blood vessels that supply blood to the heart muscles called the coronary arteries have blockages.

Angina is a common symptom of coronary artery disease which is one of the most common forms of heart disease. Affected patients describe it as a feeling of tightness, pressure, or something like a squeezing feeling in the chest. Other symptoms include pain in the neck, jaw, arms, back, or even the stomach.  These symptoms come on when the heart is working harder.

The pain is often relieved by taking nitrates or resting. If angina symptoms are prolonged or severe, it can often be a sign of more serious problems like a heart attack which is an emergency that must be promptly treated. 

Heart Attack: Symptoms and Treatment

Also known as myocardial infarction, a heart attack occurs when there is a sudden blockage in the heart’s blood supply which leads to the damage or death of the heart muscle. This medical emergency usually happens when a fatty plaque in the wall of a heart artery gets inflamed and ruptures into the artery and this causes a clot to form in the artery that suddenly blocks the blood supply.

Below are some of the common symptoms of a heart attack:

• Sweating
• Nausea
• Vomiting
• Dizziness
• Lightheadedness
• Shortness of breath
• Chest pain or discomfort (feeling of squeezing, pressure, or fullness in the chest)
• Discomfort and pain in the back, neck, jaw, arms, or stomach

Seek immediate medical attention or call your local emergency number when you suspect that you or someone else is having a heart attack. Each second counts in such an emergency since the longer the heart muscles go without a good blood supply, the bigger damage there will be.

To treat a heart attack, the blockages or blood clots that are blocking the blood flow toward the heart can often be treated or dissolved through medications. 

For more serious cases, a procedure called primary angioplasty can be performed to open the artery that has blockages. 

The rehabilitation process will include changes in lifestyle like a regular exercise routine, quitting smoking, and eating a healthy diet. This will improve and hasten recovery while helping to prevent future heart events

Related Article: Surviving a Heart Attack: Symptoms, Prevention, & What To Do

Aortic Dissection: A Life-Threatening Condition

This condition occurs when the inner layer of the aorta develops a tear. It is a life-threatening emergency since the aorta is the main artery that carries blood from the heart to the rest of the body. The inner and middle layer of the aorta can separate (dissect) when this tear happens and blood will start flowing between them. If not treated immediately, it can lead to a rupture of the aorta which is a serious and often fatal condition.

Below are the symptoms that one may experience during an aortic dissection:

• Pain that radiates to the back and the stomach
• Sudden chest pain that is often severe and unbearable
• Shortness of breath
• Rapid and irregular pulse
• Dizziness and fainting
• Numbness or weakness in the arms or legs

Contact your local emergency number immediately if you suspect that you or someone else is having an aortic dissection. Prompt treatment is crucial in a serious medical emergency like an aortic dissection. Your heart doctor may give you medications to control your heart rate and blood pressure. Surgery may also be needed so that the damaged aorta can be repaired. Here’s a guide to ensuring good heart health so you can avoid any life-threatening heart emergencies.

Pericarditis: Causes, Symptoms, and Treatment

A condition that happens when the pericardium – the thin sack that surrounds the heart – becomes inflamed. The pericardium is composed of two layers, one is the sack that surrounds the heart and the other one covers it. There is a small amount of fluid in between these layers which aid in the smooth movement of the heart as it beats and pumps blood.

The common cause of pericarditis is a bacterial or viral infection, or other serious conditions like a chest injury, autoimmune diseases, a heart attack, or even certain medications.

The symptoms of pericarditis include the following:

• Pain that worsens on deep breathing or lying down. It often improves when sitting forward. 
• Sharp chest pain that mostly located at the center of the chest
• Fatigue
• Fever
• Shortness of breath
• Irregular or rapid pulse

Pericarditis is treated using nonsteroidal anti-inflammatory drugs (NSAIDs). These medications will help lessen the inflammation and aid in relieving pain. When the case is severe, hospitalization is going to be recommended and the excess fluid around the heart may be drained. 

Consult with your trusted heart doctor in case you suspect that you or someone else has pericarditis. It is important to treat it early on to prevent any complications like pericardial effusion – a condition where excess fluid around the heart develops, or constrictive pericarditis – a condition where the pericardium scarring interferes with the heart’s normal function.

Esophageal Spasm: A Rare but Painful Condition

This is a rare disorder that involves the tube that carries the food you eat from the mouth toward the stomach known as the esophagus. It happens when involuntary contractions of the muscles in the esophagus happen causing chest pain and difficulty in swallowing.

The two types of esophageal spasms are:

1. Nutcracker esophagus – Commonly characterized by regular contractions of the esophageal muscles that are often very strong. It can result in chest pain that is severe and can sometimes be mistaken as a heart attack.
2. Diffuse esophageal spasm – Characterized by the esophageal muscles experiencing irregular contractions which causes chest pain and difficulty swallowing and is sometimes mistaken for angina, a type of chest pain that happens when blood flow to the heart is restricted.

This condition is a rare one and its cause is often unknown. It is sometimes triggered by certain foods that have been ingested, swallowing air, or drinking hot or cold liquids. This type of chest pain can also be caused by existing conditions like anxiety, GERD (gastroesophageal reflux disease), or achalasia – a condition where the esophagus’ ability to move food to the stomach is affected.

Depending on your condition, your doctor may recommend changes in diet, techniques for stress management, or even medications that can help relax the esophageal muscles. If the condition is severe, surgery may be performed to repair the esophagus.

Pulmonary Embolism: A Serious and Potentially Fatal Condition

A potentially life-threatening condition occurs when one of the arteries of the lungs suddenly gets clogged by a blood clot. The supply of blood to the affected part of the lung will then be affected which can lead to damage to the lung tissue itself and cause a reduction of oxygen that is supplied to the body’s tissues and organs.

Pulmonary embolism can cause symptoms including:

• Rapid heart rate
• Shortness of breath
• Chest pain

There are several factors that can cause pulmonary embolism including prolonged inactivity like recovery time after a major surgery, or a long plane flight. This condition is treated through medications that can help dissolve the blood clot and prevent it from forming again. If you experience such symptoms or types of chest pain, be sure to seek immediate medical attention since this condition can cause death if it is left untreated.

Costochondritis: Chest Pain from Inflammation of the Ribs

Another condition that can cause chest pain is called costochondritis. This happens when inflammation in the costochondral joint (the joint that joins the rib to the sternum) occurs. The pain that results from this condition is often described as a sharp one that gets worse with deep breathing or when the affected area is touched.

This condition is often observed in women and common treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen which can help lessen the pain and inflammation. Hot or cold compresses may also be administered along with physical therapy or sometimes, a corticosteroid injection may also be given.

Such a condition often resolves by itself within a few weeks but if the pain gets worse and keeps occurring for extended periods, it is important to seek medical attention so you can be evaluated and treated further.

GERD: Chest Pain Caused by Acid Reflux

GERD or Gastroesophageal reflux disease is a condition characterized by the flow of stomach acids upward toward the esophagus – the tube that sends food from your mouth toward your stomach. The symptoms that can occur when one suffers from this condition include the following:

• Heartburn
• Burning sensation in the chest
• Difficulty swallowing
• Chest pain

The burning sensation in the chest can often get worse when lying down or after eating. GERD is often treated using medications that help reduce the stomach’s acid production like PPIs or Proton Pump Inhibitors. Your doctor may also recommend lifestyle changes to treat GERD such as:

• Avoiding fatty foods
• Staying away from spicy foods
• Avoid eating close to bedtime

If not treated, GERD can result in more serious problems such as inflammation of the esophagus (esophagitis) or worse, Barrett’s esophagus – a precancerous condition. That is why it is important to consult with a doctor if you experience any of these types of chest pain caused by the above-listed conditions.

Panic Attacks: When Chest Pain is a Symptom of Anxiety

Another condition that can cause different types of chest pain is when you keep experiencing panic attacks. This happens when you have a sudden episode of anxiety leading to intense stress and fear leading to physical conditions or changes such as:

• Chest pain
• Rapid heartbeat
• Difficulty breathing
• Dizziness
• Nausea

Such symptoms can vary in intensity but in severe instances, the person may feel like they are experiencing heart events like a heart attack and other conditions that can be life-threatening. Triggering factors of a panic attack include:

• Health issues
• Depression and Stress
• Environmental stimuli that occur suddenly without warning

Panic attacks commonly last a few minutes but it can feel much longer to the one who is experiencing such a condition. While it can be disruptive and frightening most of the time, a panic attack is usually not as harmful as the other conditions listed above. It can easily be managed with treatment like relaxation techniques, therapy, and medications.

If you are experiencing any of the types of chest pain I have listed here or one that is related to a panic attack, be sure to speak with a healthcare professional to get a proper evaluation, advice, and treatment.

Musculoskeletal Chest Pain: Causes and Treatment Options

Lastly, another condition that can lead to different types of chest pain is one that can be caused by problems in the bones, muscles and other tissues that are present in the chest. The causes of such conditions include injury or substance overuse and the symptoms can be felt as a sharp stabbing pain or a dull ache in the chest. 

Other causes of musculoskeletal chest pain include:

• Muscle strains
• Fractures on the ribs
• Osteoarthritis

The treatment for such a condition may include rest, physical therapy, and medication. Surgery may also be needed for extreme cases to correct the existing problem like multiple broken ribs and others. If you experience such chest pain, seek advice from a healthcare provider to pinpoint the cause and receive proper advice and treatment. If you need expert advice or have questions and concerns about chest pain or any of the conditions I have explained above, consider giving us a call at +65 6235 5300.

Written by: Dr Michael MacDonald MB ChB, BSc (Hons), MRCP (UK), MD (Research), FESC (Europe).  Dr MacDonald was trained in the UK and is a senior Consultant Cardiologist.