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Understanding Chest Pain & Knowing When to Worry

man gripping chest with both hands

Chest pain is one of the scariest concerns we experience in our lives. Human nature leads us to believe that the worst may be happening – a heart attack. Fortunately, most chest pain issues, also known as angina, are far less severe, but this does not mean that chest pain should be ignored. This article will cover the common causes of chest pain and what patients should do if they feel it. Of course, if the chest pain is unusual, severe, or persistent, this may be a medical emergency, and you should call 911 or go to your nearest emergency room without delay.

Benign Causes of Chest Pain

Chest pain can be caused by trauma. For example, a blow to the chest may bruise the musculature and bone structure in the rib area. If the impact or fall causes severe pain, it’s worth seeing a doctor to ensure that more significant damage hasn’t been done.

Since we have musculature in the chest, it is common to strain those muscles, leading to dull or even sharp pain. Most patients can typically identify this as muscular pain by remembering when the initial pain started and any movements that may trigger it. Further, these pains are usually initiated or exacerbated by specific movements, making it clear that it is muscular and not something worse.

Chest pain may also be caused by acid reflux, known as heartburn. When acid refluxes up from the stomach and into the esophagus, it can cause a dull ache or burning sensation in the center of the chest. Some cases can be severe, and it is not unheard of to see a patient in the emergency room due to severe acid reflux. Consistent acid reflux is known as GERD or gastroesophageal reflux disease. This can lead to cellular changes in the esophagus and, therefore, should be evaluated by a qualified physician for treatment with medication or anti-reflux surgery.

Anxiety and other mental health concerns can also cause tightness in the chest. Particularly stressful situations can trigger a fight or flight reaction and a hormonal response. While these are typically transient and, in and of themselves, nothing to worry about, our stress response is a significant risk factor in longer-term heart disease. Patients should take measures to get their anxiety or stress under control before it begins to cause more systemic issues.

More Concerning Chest Pain

Chest pain can also be caused by issues that need more immediate care. For example, a hallmark of a cardiac arrhythmia or irregular heartbeat is the feeling that one’s heart is beating out of the chest. Chest pain is also common. Arrhythmias that occur in the atria or upper chambers of the heart are typically less immediately concerning than those in the ventricles. For example, atrial fibrillation or Afib, the most common arrhythmia in the United States worldwide, affects up to 5 million Americans and does not represent an immediate risk to the patient. However, even these arrhythmias can eventually lead to a much-increased risk of stroke, heart attack, and longer-term heart failure. Patients must visit their Electrophysiologist as soon as possible to get a proper diagnosis.

Of course, no discussion about chest pain would be complete without discussing heart attack and heart attack risk. When chest pain is caused by atherosclerosis or the narrowing of arteries due to the buildup of plaque along their walls, this can reduce the amount of oxygenated blood entering the heart. The result can be a heart attack if the coronary arteries are significantly occluded. Often a harbinger of more arterial severe disease is erectile dysfunction, especially in middle age and older men. Peripheral artery disease, too, can manifest in pain and loss of sensation in the extremities and can also be a sign of future serious cardiovascular disease. As such, if your diet is not optimal, or if you have lived with excess weight or obesity for a while, and you begin to feel chest pain, a visit to your cardiologist is not only appropriate but urgent. If the pain persists, comes and goes, becomes significant, is accompanied by breathlessness and fainting, pain in the jaw, arm, shoulder, or stomach, or otherwise feels unusual, go directly to the ER or call 911 for emergent care.

Ultimately, there are many reasons for chest pain, none of which should be ignored. When in doubt, always speak to your medical provider, or go to the emergency room to avoid the possibility of a heart attack.

It is also worth noting that women often experience different symptoms of a heart attack, many of which are not what we traditionally see on TV. Particularly serious or intense indigestion and other unusual metabolic symptoms can signify a heart attack. So, women should not believe that because heart attacks are more often associated with males, they are not having one – always get immediate and emergency care.