The chest pain checklist

The aim of this blog post is to provide you, our dear reader, some important facts and points about chest pain and thereby empower you to take the right decision when you or your loved one encounters it.

Chest pain is probably the most feared of all pains, mainly due to its association with heart problems. In fact, it is the second most common reason for presenting to the hospital emergency department across the globe (injury being the leading cause). Here are 5 common causes of chest pain and some tips to differentiate one from the other:

  1. Gastric acidity or heartburn
  2. Heart attack or angina
  3. Lung related causes
  4. Musculoskeletal problems
  5. Neurological pain

Gastric acidity or heartburn

Gastric acidity is also referred to as heartburn because it causes a burning sensation in the middle portion of the chest, typically behind the chest bone. The rising up of gastric juices from the stomach to the tube connecting the mouth and stomach (esophagus) and irritation of the inner lining of the tube is the cause for this burning sensation.

A few indicators of heartburn are:

  • Timing of the pain – the pain might occur before a meal if you often have untimely meals or skip meals
  • Association with food types – heavy meals or food with excessive oil and spice might trigger the discomfort
  • Response to antacids – if the pain or burning sensation subsides with over-the-counter liquids or tablets for acidity, it is likely a heartburn

Heart attack or angina

Chest pain due to cardiac causes can be very severe and sinister. It is important to know that the following causes may lead to cardiac related chest pain:

  • Sudden unbearable pain in the chest or upper part of the body due to a complete block of the blood vessel supplying the heart (myocardial infarction or heart attack)
  • A gradually building up chest pain which worsens during exercise or emotional bursts and gets relieved with rest or relaxation is called angina and is due to poor blood supply to the heart
  • A stabbing or piercing pain of the chest may be due to a tear of the major blood vessel leaving the heart or disease of the covering of the heart

Note: As heartburn and heart attack pain can mimic each other, it is best to see a doctor and get an electrocardiogram or ECG test at the earliest. Also, a healthy lifestyle which includes a balanced healthy diet in a timely manner, regular exercise and stress relieving techniques such as yoga, meditation and deep breathing, is extremely effective in keeping both heart related and gastric acidity related problems at bay.

Lung related causes

A few conditions like infection of the lungs, inflammation of the covering layer of the lungs, block in the artery supplying blood to the lungs and high blood pressure in the blood vessels carrying blood to the lungs can cause chest pain. The clues here are pain that worsens with deep breathing or coughing and at times associated with shortness of breath. As some of the causes are potentially lethal, it is imperative to consult a physician if the pain is severe or associated with difficulty breathing.

Musculoskeletal problems

Injuries to the muscles in the chest region or the ribs and the surrounding cartilages can cause chest pain. Pain on pressing a particular spot, also called tenderness, is an indicator of an underlying soft tissue or bony problem. The pain usually gets better with application of cold or hot fomentation or with anti-inflammatory drugs if it is soft tissue related.

Neurological pain

Any radiating pain in the neck, upper chest, upper back and arm can be due to nerve compression. The severity of pain may be more with upper body and arm movements and may be associated with other symptoms like tingling sensation, numbness etc.

Panic attack is another well-known cause of chest pain. You might not have any of the problems mentioned above but may experience a severe chest pain together with intense fear, rapid heartbeat, rapid breathing, profuse sweating, nausea and dizziness.

Shingles or herpes zoster infection of the chest region can cause a severe chest pain along with a band of blisters from the back to the front of the chest.

While chest pain may be due a variety of causes, cardiac and certain lung causes may be life threatening and should be addressed immediately without any time delay. So, here is the checklist for someone experiencing chest pain:

  • Is this a new-onset pain?
  • Is the pain severe or unbearable?
  • Is the pain radiating (spreading from one point to other areas)?
  • Is the pain associated with exercise or emotions?
  • Is the pain associated with meals, cough, deep breathing etc?
  • Is the pain getting better with over-the-counter drugs?
  • Is the pain lasting for days to weeks?
  • Is the pain getting better with local application of muscle relaxants or cold/hot fomentation?

While this post may come in handy when someone you know has chest pain, we strongly recommend consulting your physician to rule out serious medical conditions.

Are Fitness Apps and Devices safe for everyone?

The world today is more digital than it has ever been before! Smart phones and the associated apps have become an integral part of our work lives, family lives and social lives. People often use fitness apps for exercising these days. Let us take a look at some of the benefits and harms of this trend.

Fitness apps help us exercise better in the following ways:

  • Provide multiple exercise options and range of exercises for individuals who exercise on a regular basis (abdominal exercises, core strengthening, etc)
  • Provide reminders to help us stick to our exercise routine
  • Monitor key parameters like heart rate, steps per day and calorie intake and calorie expenditure and helps keep track of these numbers over time.
  • Help us work on different aspects such as aerobic exercises, strength training, interval training, circuit training and on particular areas like core muscles, upper limbs etc. if necessary

Even though fitness apps and devices help us exercise ourselves without the need for someone to supervise us, there are a few things that we should be aware of before starting to use one of these.

  • Anyone new to exercise should have a medical evaluation for underlying conditions like diabetes, hypertension and obesity as the fitness app or device will not scan for these conditions
  • When beginners indulge in strength training or vigorous intensity exercises without assessing their muscle strength and endurance, it may lead to injury of muscles, ligaments and joints if not done the right way.
  • App-based dietary advice to lose weight or burn more calories are not individualised and safe; hence they can cause excess fatigue, dehydration, fluid imbalance, giddiness and loss of conscious
  • Even though apps may provide illustrations or short videos on how an exercise is to be done, it is always advisable to have a fitness trainer or a physiotherapist to correct you in the early stages

Special advice for heart patients:

While all the benefits and limitations discussed above apply to cardiac patients also, it is important to note that fitness apps, devices and even physical trainers in most commercial gyms are unable to provide a personalized exercise prescription that is effective and safe for your medical condition. They are not trained to assess your heart rate, blood pressure and other symptoms like sweating, breathlessness and chest pain during exercise and this might lead to complications like abnormal heart beat, very high or very low blood pressure, sudden collapse etc. It is mandatory to consult your cardiologist or your cardiac rehab team to understand how to exercise safely and follow their guidance. Initiating the exercise regime under medical supervision and then gradually using relevant apps and devices as an adjunct is advisable.