When do you go to the emergency room due to chest pain?

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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 :

dissection (1)                                           


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

Posted by on Aug 21 2013. Filed under Community News. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry

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