Chest pain

Chest pain appears in many forms, ranging from a sharp stab to a dull ache.
Sometimes chest pain feels crushing or burning. In certain cases, the pain travels up
the neck, into the jaw, and then radiates to the back or down one or both arms.
Many different problems can cause chest pain. The most life-threatening causes
involve the heart or lungs. Because chest pain can indicate a serious problem, it's
important to seek immediate medical help.
Chest pain can cause many different sensations depending on what's triggering the
symptom. Often, the cause has nothing to do with your heart — though there's no
easy way to tell without seeing a doctor.
Heart-related chest pain

• Although chest pain is often associated with heart disease, many people with heart disease say
they experience a vague discomfort that isn't necessarily identified as pain. In general, chest
discomfort related to a heart attack or another heart problem may be described by or
associated with one or more of the following:
• Pressure, fullness, burning or tightness in your chest
• Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms
• Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or
varies in intensity
• Shortness of breath
• Cold sweats
• Dizziness or weakness
• Nausea or vomiting
 Other types of chest pain

• It can be difficult to distinguish heart-related chest pain from other types of

chest pain. However, chest pain that is less likely due to a heart problem is
more often associated with:
• A sour taste or a sensation of food re-entering your mouth
• Trouble swallowing
• Pain that gets better or worse when you change your body position
• Pain that intensifies when you breathe deeply or cough
• Tenderness when you push on your chest
• Pain that is persistently present for many hours.
 Causes

• Heart-related causes
• Examples of heart-related causes of chest pain include:
• Heart attack. A heart attack results from blocked blood flow, often from a blood clot, to your heart
muscle.
• Angina. Angina is the term for chest pain caused by poor blood flow to the heart. This is often caused
by the buildup of thick plaques on the inner walls of the arteries that carry blood to your heart. These
plaques narrow the arteries and restrict the heart's blood supply, particularly during exertion.
• Aortic dissection. This life-threatening condition involves the main artery leading from your heart
(aorta). If the inner layers of this blood vessel separate, blood is forced between the layers and can
cause the aorta to rupture.
• Pericarditis. This is the inflammation of the sac surrounding your heart. It usually causes sharp pain
that gets worse when you breathe in or when you lie down.
• Digestive causes
• Chest pain can be caused by disorders of the digestive system, including:
• Heartburn. This painful, burning sensation behind your breastbone occurs
when stomach acid washes up from your stomach into the tube that
connects your throat to your stomach (esophagus).
• Swallowing disorders. Disorders of the esophagus can make swallowing
difficult and even painful.
• Gallbladder or pancreas problems. Gallstones or inflammation of your
gallbladder or pancreas can cause abdominal pain that radiates to your
chest.
• Muscle and bone causes
• Some types of chest pain are associated with injuries and other problems
affecting the structures that make up the chest wall, including:
• Costochondritis. In this condition, the cartilage of your rib cage, particularly
the cartilage that joins your ribs to your breastbone, becomes inflamed and
painful.
• Sore muscles. Chronic pain syndromes, such as fibromyalgia, can produce
persistent muscle-related chest pain.
• Injured ribs. A bruised or broken rib can cause chest pain.
• Lung-related causes
• Many lung disorders can cause chest pain, including:
• Pulmonary embolism. This occurs when a blood clot becomes lodged in a lung
(pulmonary) artery, blocking blood flow to lung tissue.
• Pleurisy. If the membrane that covers your lungs becomes inflamed, it can cause
chest pain that worsens when you inhale or cough.
• Collapsed lung. The chest pain associated with a collapsed lung typically begins
suddenly and can last for hours, and is generally associated with shortness of
breath. A collapsed lung occurs when air leaks into the space between the lung
and the ribs.
• Pulmonary hypertension. This condition occurs when you have high blood
pressure in the arteries carrying blood to the lungs, which can produce chest pain.
 Dyspnea

• Shortness of breath (SOB), also known as dyspnea, is a feeling of not being able to breathe well enough.
• Dyspnea can happen as a result of overexertion, spending time at high altitude, or as a symptom of a
range of conditions.
• Signs that a person is experiencing dyspnea include:
• shortness of breath after exertion or due to a medical condition
• feeling smothered or suffocated as a result of breathing difficulties
• labored breathing
• tightness in the chest
• rapid, shallow breathing
• heart palpitations
• wheezing
• coughing
• If dyspnea occurs suddenly or if symptoms are severe, it may be a sign of a serious medical condition.
 Causes
• An episode of dyspnea is not always directly related to an individual’s health. A person can feel short of breath
after intense exercise, when traveling to a high altitude, or going through major temperature changes.
• Dyspnea caused by medical conditions covers a wide range of health concerns. While they should all be evaluated
by a doctor, conditions that bring on sudden breathlessness should be treated as emergencies. These include:
• heart failure
• low blood pressure
• pneumonia
• pulmonary embolism (a blood clot in the lungs)
• carbon monoxide poisoning
• stress or anxiety
• chronic obstructive pulmonary disease (COPD), which covers emphysema and chronic bronchitis
• interstitial lung disease (scarring of lung tissue)
• poor physical conditioning
• obesity
• heart disease
 Functional classes

Degree of dyspnea
grades

0 no dyspnea except with strenuous exercise

dyspnea when walking up an incline or hurrying on the

1 level

walks slower than most on the level, or stops after 15

2
minutes of walking on the level

3 stops after a few minutes of walking on the level

4 with minimal activity such as getting dressed, too dyspneic

to leave the house
Orthopnea

• Orthopnea or orthopnea is shortness of breath (dyspnea) that occurs

when lying flat, causing the person to have to sleep propped up in bed
or sitting in a chair. It is commonly seen as a late manifestation
of heart failure, resulting from fluid redistribution into the central
circulation, causing an increase in pulmonary capillary pressure.
Paroxysmal nocturnal dyspnoea

• paroxysmal nocturnal dyspnea (PND) is an attack of severe shortness

of breath and coughing that generally occur at night. It usually
awakens the person from sleep, and may be quite frightening.
• Though simple orthopnea may be relieved by sitting upright at the
side of the bed with legs dangling, in those with PND, coughing and
wheezing often persist in this position.
 Palpitations

• Palpitations are the perceived abnormality of the heartbeat characterized

by awareness of cardiac muscle contractions in the chest, which is further
characterized by the hard, fast and/or irregular beatings of the heart. It is
both a symptom reported by the patient and a medical diagnosis.
• Symptoms include a rapid pulsation, an abnormally rapid or irregular
beating of the heart.
• Palpitation can be associated with anxiety and does not necessarily indicate
a structural or functional abnormality of the heart, but it can be a symptom
arising from an objectively rapid or irregular heartbeat. 
 Syncope (Fainting)

• Syncope is a temporary loss of consciousness usually related to insufficient

blood flow to the brain. It's also called fainting or "passing out."
• It most often occurs when blood pressure is too low (hypotension) and
the heart doesn't pump enough oxygen to the brain. It can be benign or a
symptom of an underlying medical condition.
• Cardiac or cardiovascular syncope is caused by various heart conditions,
such as bradycardia, tachycardia or certain types of hypotension, mitral
stenosis, pulmonary hypotension, complete heart block.
 Dependent Edema

• Edema is the medical term for swelling. It happens when extra fluid gets
trapped in your body’s tissues. There are several types of edema, which can
be the result of a variety of medical problems, such as congestive heart
failure, cirrhosis, and kidney disease.
• Dependent edema is a term that doctors use to describe gravity-related
swelling in the lower body. Gravity has the effect of pulling fluid down
toward the earth, causing it too pool in the lowest parts of your body, such
as your feet, legs, or hands.
• Edema can be the result of medication, pregnancy or an underlying disease
— often congestive heart failure, kidney disease or cirrhosis of the liver.
Grades

• Grade 1: The pressure applied by the doctor leaves an indentation of

0–2 millimeters (mm) that rebounds immediately. This is the least
severe type of pitting edema.
• Grade 2: The pressure leaves an indentation of 3–4 mm that rebounds
in fewer than 15 seconds.
• Grade 3: The pressure leaves an indentation of 5–6 mm that takes up
to 1-2 minutes to rebound.
• Grade 4: The pressure leaves an indentation of 8 mm or deeper. It
takes more than 5 min to rebound.
 Hemoptysis

• Hemoptysis is the coughing up of blood or blood-stained mucus from

the bronchi, larynx, trachea, or lungs. In other words, it is the airway
bleeding. This can occur with lung cancer, infections such
as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular
conditions. Hemoptysis is considered massive at 300 mL (11 imp fl oz;
10 US fl oz). In such cases, there are always severe injuries.
• Blood-laced mucus from the sinus or nose area can sometimes be
misidentified as symptomatic of hemoptysis (such secretions can be a sign
of nasal or sinus cancer, but also a sinus infection). Extensive non-
respiratory injury can also cause one to cough up blood. Cardiac causes
like congestive heart failure and mitral stenosis should be ruled out.
 Cyanosis

• Cyanosis is the bluish or purplish discolouration of the skin or mucous

membranes due to the tissues near the skin surface having low oxygen
saturation.
• it is classically described as occurring if 5.0 g/dL of deoxyhemoglobin or
greater is present.
• When signs of cyanosis first appear, such as on the lips or fingers,
intervention should be made within 3–5 minutes because a
severe hypoxia or severe circulatory failure may have induced the cyanosis.
• Cyanosis is divided into two main types: central (around the core, lips, and
tongue) and peripheral (only the extremities or fingers).
 Nail clubbing

• Nail clubbing, also known as digital clubbing or clubbing, is a deformity of

the finger or toe nails associated with a number of diseases.
• Clubbing is associated with lung cancer, lung infections, interstitial lung
disease, cystic fibrosis, or cardiovascular disease. Clubbing may also run in
families, and occur unassociated with other medical problems.