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Chest pain

Chest pain can be a worrying symptom that can develop at anytime in any person. Reassuringly not all chest pain is serious but it is recommended that if you do experience recent on set chest pain or discomfort that you seek medical advice sooner rather than later.


Symptoms
Most people who have had a heart attack do not describe the
discomfort they experience as pain. Chest pain caused by a lack of blood flow to the heart is usually exertional in nature and eases with rest. The character of the pain is heavy, tight, constricting, vice-like.  The discomfort may radiate to the jaw, teeth, left shoulder and down the left arm to the hand.  Occasionally the discomfort may radiate to the back. There is usually associated sweating, shortness of

breath and nausea.
 

Causes
There are a number of different causes of chest pain, some are potentially serious and others are not.

Cardiac causes

  • Heart attack – blocked artery leading to death of the heart cells ‘down-stream’ of the blockage

  • Angina – chest discomfort usually caused by a narrow artery that supplies the heart muscle

  • Pericarditis – inflammation of the lining of the heart usually caused by a viral infection

  • Heart rhythm abnormalities – occasionally fast heart rhythms can result in chest discomfort when the heart rate is excessively rapid caused by viral infections and usually settles with rest

  • Myocarditis – this is inflammation of the heart muscle that can be

  • the aorta and usually requires emergency treatmentcondition usually affecting main blood vessel that leaves the heart, Tearing of blood vessel – this is a rare and potentially dangerous

 

Lung causes

  • Pulmonary embolism – a clot in the blood vessels within the lungs can result in chest pain that is usually worse when taking a deep breath in. 

  • Infection – a lung infection can occasionally cause a sharp discomfort in the chest that is worse when taking a deep breath in.

  • Muscular- skeletal chest pain. There are a number of painful conditions that arise from the spine, ligaments and connective tissues in the chest wall that can become inflamed and result in chest discomfort

Investigations
ECG or electrocardiogram is an electrical reading of the heart that is performed by placing electrode stickers on the skin of the chest wall.  The ECG is usually abnormal during a heart attack but is often normal in angina.


Chest X-ray examination can help exclude non-cardiac causes of chest pain
 

Blood tests such a measurement of the troponin protein that is released from the heart cells when the heart has been damaged during a heart attack.


Ultrasound of the heart or echocardiogram is a test used to assess the structure and function of the heart
 

Coronary angiography involves injecting contrast material through a tube that is passed from the artery in the wrist and passes into the arteries of the heart. This will demonstrate whether the arteries are blocked or open.
 

CT scans can demonstrate whether the arteries are blocked or likely to be blocked.


Stress ultrasound of the heart or stress echocardiogram is a test used to assess the function of the heart whilst you wither undertake exercise or you are given a medicine that speeds up your heart rate.
 

MRI (magnetic resonance imaging) is occasionally used to assess the structure and function of the heart and can be used to see how much blood flow there is to the heart muscle.


Exercise tolerance test or exercise treadmill test is a test that can be used to assess a how the ECG changes during exercise.

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