Thoracic pain

Overview: What is chest pain?

In the case of chest pain, those affected have discomfort in the chest area. The causes can be harmless, but also life-threatening. They range from a hypersensitive esophagus to a heart attack. In the event of severe pain and serious accompanying symptoms such as shortness of breath or palpitations, you should call the emergency services (144) immediately.

Chest pain: causes and risk factors

There are many different reasons for chest pain. Some are related to the heart (cardiac cause), others involve other organs or diseases (non-cardiac cause).

Angina pectoris

One of the most common triggers for so-called cardiac causes is an attack of angina pectoris. It can be a symptom of coronary heart disease (CHD). Angina pectoris is one of the most common widespread diseases and can be fatal if not treated in time. Coronary heart disease is a circulatory disorder of the heart: Deposits cause the coronary arteries to become increasingly narrow, which reduces the oxygen supply to the heart muscle. This results in chest pain, which is often accompanied by shortness of breath and anxiety.

Chest pain during a heart attack

Chest pain can also be a symptom of a heart attack. Cells of the heart muscle die because they are no longer supplied with blood. Common symptoms of a heart attack are

• Chest pain – it can radiate into the arms and jaw
• Paleness
• Sweating/cold sweat
• Nausea
• Shortness of breath
• Fear

If you have these symptoms, you should call the emergency services immediately on 144. The sooner the affected person gets to hospital and can be treated with life-saving measures, the greater the chances of surviving a heart attack.

Chest pain: other heart diseases

Cardiac arrhythmias can be the cause of chest pain. Those affected suffer from

• Heart palpitations,
• Heart stumbling or slow heartbeats,
• Weakness,
• Dizziness,
• Drowsiness and even loss of consciousness,
• Nervousness.

Inflammation of the pericardium may also cause chest pain. This so-called pericarditis is caused by respiratory infections that are triggered by viruses. It leads to the following symptoms:

• Fever,
• Sharp pain in the sternum, which intensifies when inhaling, coughing, moving or lying down,
• Cough or sore throat.

Inflammation of the heart muscle can also be accompanied by chest pain. The symptoms are often very different and general. They range from fatigue and shortness of breath to palpitations. Sometimes there are no symptoms.

Other possible causes

Chest pain does not always have to be associated with a diseased heart. Sometimes they are also an indication of diseases of other organs or injuries to the muscles in the chest area. The following causes are possible:

• Reflux disease: refluxing gastric juice triggers inflammation in the esophagus
• Esophageal spasm or tear in the esophagus
• Pancreatitis or gastritis
• Biliary colic
• Pneumonia or pleurisy
• Pulmonary embolism
• Air between the lungs and chest wall
• COPD or asthma
• Injuries such as bruises or fractures
• Diseases of the skeleton of the chest wall
• Chest infections
• Metastases on the chest wall or pleura
• Aortic dissection: splitting of the wall layers of the aorta
• Nerve pain, for example with shingles
• Depression, anxiety disorders or psychosomatic illnesses
• Sarcoidosis: small nodules in the organs, especially in the lungs and lymph nodes
• Systemic lupus erythematosus: rare autoimmune disease with foci of inflammation throughout the body

Chest pain: risk factors

As there are many possible causes of chest pain, the risk factors are varied. The risks for cardiovascular diseases are:

• Age,
• Lack of exercise,
• High blood pressure,
• Diabetes,
• Smoking,
• elevated cholesterol levels,
• Obesity
• Positive family history(CHD or myocardial infarction in 1st degree relatives).

Chest pain: symptoms of varying severity

The symptoms of chest pain vary depending on the cause and are of varying severity. Some sufferers only report chest pain, while for others the pain radiates to the back, arms or lower jaw. The symptoms may only last for a short time or may persist for longer. Sometimes they are associated with breathing or also occur at rest.

In addition to chest pain, there may be other symptoms, depending on the underlying disease. For example:

• Shortness of breath
• Nausea and vomiting
• Palpitations
• Heartburn
• Sweating
• Fear

We use the analysis of the accompanying symptoms for our diagnosis.

Diagnosis of chest pain

First we will ask you about your symptoms (medical history). We are interested, for example:

• Where exactly does the pain occur?
• How do they feel?
• Does the pain tend to be stabbing, pressing or burning?
• How long have you been in pain?
• Is the pain continuous or does it recur?
• Do the symptoms increase during certain activities, for example when moving, breathing deeply or eating?
• Is the pain accompanied by other symptoms such as nausea or fever?

We need to know all of this in order to get a picture of your illness. We also find out about your previous illnesses and risk factors.

Further examinations for chest pain

The next step is the physical examination, which is carried out as follows:

• We measure blood pressure.
• We take a blood sample.
• We listen to the heart and lungs.
• We arrange for an ECG. The electrical excitation of the heart is recorded in order to detect any irregularities.

Based on the examination results, we can get an idea of which disease could be the cause of the chest pain. If necessary, we can use further diagnostic procedures:

• X-ray of the chest area
• Ultrasound examination of the heart
• Computed tomography
• Magnetic resonance imaging
• Positron emission tomography
• Scintigraphy
• Exercise ECG
• Cardiac catheterization: Examination of the heart vessels with contrast medium

Chest pain: prevention and prognosis

The prognosis associated with chest pain depends on the underlying cause. Harmless triggers such as reflux disease are easy to treat, but serious causes such as heart attacks are life-threatening and require complex, lengthy treatment. Chest pain alone says nothing about the disease that may be behind it. In this respect, there are only general recommendations on how you can prevent heart and lung diseases. In general, it can be said that a healthy lifestyle helps to prevent many diseases. So make sure you exercise regularly, eat a healthy diet and balance stress with sufficient rest periods.

Chest pain: treatment depending on the cause

The therapy depends on the cause. Because the causes of chest pain are so varied, there are also very different treatment options.

Treatment of heart disease

If the chest pain is the result of an angina attack, the patient is given nitroglycerin. It usually stops the symptoms quite quickly. However, if the symptoms are due to a heart attack, rapid action is required. A heart attack usually requires immediate treatment with a cardiac catheter, whereby the blocked vessel can be reopened and fitted with a stent.

Medication for reflux disease and pleurisy

People with reflux disease experience heartburn and chest pain, especially after meals. They are helped by medication that reduces or neutralizes stomach acid. In the case of pleurisy, patients are given antibiotics to eliminate the pathogens. We will explain to you exactly which therapy is most promising for you.