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What causes chest pain?

Written by: Dr Sohail Q Khan
Edited by: Laura Burgess

Chest pain can be caused by a variety of reasons, including things like angina or a heart attack but we also know palpitations can bring on chest pains. These are the worrying causes but there are others as well such acid reflux, and even the chest wall itself can precipitate pain. The chest is made up of the breastbone and also muscles in the space between the ribs, meaning the pain can come from any of those sources. It can also be caused by the lungs and is usually exacerbated when someone breathes in or out. Anxiety is another common cause that we see in patients as well.

What should you do if you experience chest pain?

Central chest pain is certainly something to be concerned about. Things to look out for include whether it comes on in the centre of the chest suddenly and is made worse with exertion. This might be indicative of angina. If this is the case then it is certainly something to discuss with your general practitioner. If the pain persists and is associated with breathlessness, sweating and a clammy sensation, you have to be concerned that this might be a heart attack. I would always recommend that you let your loved ones know at home and ask somebody, or maybe yourself, dial 999 and call for an ambulance.


How do you know if chest pain is a heart attack or something else?

Pain of a heart attack (myocardial infarction) comes on suddenly in the centre of the chest. Patients usually describe a tight sensation, a band-like feeling in the chest, which usually spreads up into the jawline. It can occasionally go down into the left arm. Patients have also described pain radiating or spreading through into the back or into the right arm. The worrying feature of the pain is that it is persistent and can go on for 20-40 minutes. This is a pain that needs to be taken seriously. Patients usually complain of being short of breath at the same time. They may feel symptoms of sweatiness, clamminess, light-headedness or feel dizzy. I advise that patients dial 999 and ask for an ambulance to attend urgently as they may be experiencing a heart attack and will need to be transferred to a hospital for rapid treatment.


How are the symptoms of chest pain diagnosed?

Your GP will refer you to a specialist depending on what they think is the most likely cause of the chest pain. If you are referred through to a cardiologist we will carry out further investigations to make sure that the chest pain is not angina. Some of the tests that we would normally undertake would include a stress test. This test is designed to see what your exercise capacity is like and whether or not exercise will bring on some of the symptoms of angina. The classical pain of angina is usually a pain in the centre of the chest, which is made worse with exertion and eased by rest. Having a patient exercise can bring out some of these symptoms and help with a diagnosis.

Other investigations would include a CT scan of the heart arteries to see if there are any potential blockages in the heart artery supplying the heart muscle. We may even consider doing a test called an angiogram, which is invasive but allows us to look directly at the arteries to determine whether or not there are any narrowings.


What are some of the treatments for chest pain?

If your doctor diagnoses you as having angina, there are a variety of treatments that are available for them to administer. There are medications which are designed to dilate or increase the blood flow to the heart muscle, such as the Sublingual GTN Spray. There are other treatment options available as well.

If you've had an angiogram done and the doctors found narrowings in the heart arteries, they may consider sending you for a procedure called an angioplasty. This involves passing a small wire into the heart, dilating any narrowings with a balloon and usually deploying a stent (a metal meshwork) to allow blood to flow normally. If there is extensive disease in the heart arteries, your doctor might consider whether you need to have a bypass done. This is performed under general anaesthesia and is an open-heart procedure.

Aside from this, there are other medications that are useful. Statin therapies particularly can help stabilise any narrowings in the heart arteries and this is usually a treatment that would be given alongside aspirin, a blood thinner that allows the blood to flow more freely in the heart arteries.

By Dr Sohail Q Khan

Dr Sohail Q. Khan is a leading consultant cardiologist, with private clinics across Birmingham. He specialises in interventional cardiology, high risk coronary intervention, along with all kinds of general cardiology. He initially qualified in medicine from the University of Edinburgh in 1999 before being awarded a fellowship from the British Heart Foundation for research into cardiac biomarkers. He went on to complete cardiology training in Manchester before being receiving the prestigious Boston Scientific Fellowship for Advanced Coronary Intervention training at the University of Toronto, Canada.

Dr Sohail Khan has published numerous articles in peer-reviewed journals, and has presented internationally in the USA, Europe, and Asia. He also devotes time to undergraduate and postgraduate training.

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