When do you go to the emergency room due to chest pain?
Chest pain is a frequent daily complaint for many people. This could be due to a simple problem such as : chest muscular strain , ribs pain , esophageal reflux disease ( acid reflux from stomach up to the esophagus ), inflammation of skeletal joints in the chest ( the joints between sternum and ribs ) , cardiac neurosis ( a psychological disorder in which patients think they have heart problems but there is no physical evidence ) and many others …..
Chest pain can also be due to a severe problem like coronary heart disease ( MI; myocardial infarction) , pericarditis ( inflammation of the heart covering membrane ) , pulmonary embolism ( blockage of lung vessels ) or aortic dissection . The latter four are emergency cases which require immediate intervention. Although this is a broad subject that cannot be covered in this piece, it is important to give the general public a brief description of each of these emergency cases:
1- (MI) myocardial infarction; heart vessel blockage:
It is a disease of whereby blood flow to the heart is stopped due to a (complete or partial ) blockage of the coronary vessel which supplies blood to
The heart
Symptoms : patient usually feels a central chest pain ( heaviness-like ) that radiates to the left arm or the lower jaw and lasts for 30 minutes . This pain is aggravated by exercise, and does not respond to sub-lingual isordil (coronary vessel dilator drug ) .
Causes : Uncontrolled diabetes , uncontrolled hypertension , high blood cholesterol , smoking ,drug abuse , alcohol , hereditary among other are the main causes .
Note : The elderly or chronic diabetics might have Silent MI “ without chest pain” . Patients might feel general weakness as a
Sole complaint.
2- Pericarditis :
The heart normally is surrounded by a covering membrane called the pericardium, which is a target for some microbes, especially some types of viruses .
Symptoms : Patient usually feels chest pain which is aggravated by lying down on the back ( supine position ) , and relieved by leaning forward . It is sometimes associated with fever.
Treatment : Anti-inflammatory drugs like aspirin or cortisone . also, anti-microbial drugs might be needed in some cases .
3- Pulmonary embolism:
Each lung is supplied by two vessels which could be blocked completely or partially , one vessel or more .
Causes : There are many causes for a pulmonary embolism such as irregular heartbeats (arrythmia) , high level hemoglobin ( polycythemia ) like in smokers , bone marrow disease and others . A main cause of pulmonary embolism is thrombosis of leg veins ( DVT : Deep Vein Thrombosis ) , which is a formed clot in deep leg veins that dislodges and travels through blood circulation until it reaches the lung vessels and causes blockage .
Who is at risk of developing DVT?
It is present in females (more than males), aged around 40 years . Risk increases during the late period of pregnancy (last three months) and the first two weeks after delivery ( pre-eclampsia ) . Contraceptive pill users, smokers, those travelling on a long journey, prolonged hospital admission especially after trauma, cancer patients , and others .
Symptoms of pulmonary embolism: Patient might feel chest pain associated with shortness of breath, increased heart rate and increased breathing rate. These symptoms can also be accompanied by blood-stained coughing.
4- Aortic dissection :
The blood leaves the heart through a big vessel called the aorta, which consists of 3 layers.
How dissection occurs?
A vessel wall disease or hypertension can sometimes lead to hole formation in the inner vessel wall which deviates the blood flow from the lumen to the wall ( between the layers ),ultimately, narrowing the vessel lumen and decreases the blood flow through the lumen .
Causes :
Smoking , hypertension and /or inflexibility of the vessels .
Symptoms :
Patient might feel chest pain (tearing-like ) , radiating to the upper-middle back , accompanied by decreased blood pressure .This type of presentation usually requires surgery .
Conclusion :
Chest pain is a common and frequent hospital case which is usually thought to arise from heart problems only, but this is not always the case .
Editor: Dr.Abdullah Sharaf Alrajhi , MD