One of the most common sites of pain anywhere in the body is chest pain, and ironically it is one of the problems we have never discussed on this page. Chest pain is the reason for some of the most frequent visits to the emergency room in many countries around the world and it is estimated to affect 20 to 40 percent of the general population. Sometimes, the pain itself is mild and the sufferer may not even complain about it but sometimes, it is so severe that the person could feel that death is imminent. In this week’s essay, we shall look at the various causes of this phenomenon and discuss the different modes of managing it. As a rule, chest pain can arise from an infection in the lungs where it may be called pneumonia or pneumonitis, a heart attack, an injury to the ribs, a muscle strain or even a panic attack. We shall begin to discuss these potential causes of chest pain in the subsequent paragraphs and take cognizance of the fact that a topic of this nature is too wide to be adequately discussed in a single essay. With that in mind, we may be compelled to do a follow-up on this initial bit depending on how much ground we can cover this week. This is no doubt, a very important topic and over the last several months, many readers have posed numerous questions related to the issue of chest pain. Part of the motivation to write this essay today is based on those questions.
One of the most common of these chest conditions is tuberculosis, a chronic infection that affects the lungs most and which we have previously discussed on this page about ten years ago. It can cause a bad cough which may become productive of sputum or blood and also cause chest pain. There may also be associated night sweats, fever and weight loss. Considering how this disease used to be in the past when many people died from it, it is largely curable these days with the deployment of the appropriate antibiotics. This aspect of the disease is known as pulmonary tuberculosis in recognition of the fact that the lungs are where it is often to be found. Another common cause of chest pain is the common breathing disorder known as bronchial asthma. We have also previously discussed this problem and recognized that it is characterized by inflammation in the airways leading to its clogging up with mucus. These events then lead to a tightness in the chest, coughing, wheezing, chest pain and shortness of breath. In the same way, pneumonia often leads to chest pain, fever, cough and shortness of breath. Coughing may bring up phlegm which could be yellow, milky, greenish, or contain blood. Breathing is usually shallow and fast and there is an associated low energy level with easy tiredness and loss of appetite. Chest pain may not be obvious in those children who are less than 5 years of age and cannot appropriately describe their symptoms.
At the extremes of age, like infants and in those above 70 years of age, pneumonitis which is often a more generalized kind of lung infection can also lead to chest pain in addition to the other features already mentioned. These seniors may also develop some degree of confusion as well as the amount of oxygen supply to the brain becomes less than optimal. This picture is quite similar to that seen in association with pulmonary embolism. This results when a blood clot becomes trapped within the artery feeding blood to the lungs. As a result, chest pain easily becomes one of the earliest symptoms. There will be back pain also. This is often a life-threatening emergency situation during which the patient feels lightheaded, and experiences dizziness and pain and swelling in the legs. The person may cough out blood and the sputum is often frothy. Sweating is profuse and death often ensues when there is no emergency treatment. As a valuable addition, lest we forget, it is important to include covid-19 here as a potential cause of chest pain. Two of my close friends who were recently on international flights developed unrelenting cough and were subsequently found to be positive for the virus. Such people may experience difficulty with breathing, persistent pressure or pain in the chest and some difficulty with staying awake. Among chest conditions that often lead to pain is a problem called pleurisy in which the membrane covering the lungs becomes inflamed. In this situation, there is a sharp chest or shoulder pain that worsens with breathing, coughing and sneezing. While the pain is often described as sharp, it can also be dull and persistent.
Similarly, a lung collapse caused by a pneumothorax can often lead to chest pain. This happens when air builds up in a space between the lungs and the ribs thereby causing the lungs to collapse. Such a patient will experience some difficulty with breathing, a faster breathing rate, shortness of breath an obvious swelling in one side of the chest. There develops a certain kind of chest pain which can radiate to the shoulder. When the chest is examined with a stethoscope, the breath sounds on that side of the chest are noticed to be reduced and somewhat distant. Besides all these causes related to lung infections, similar pain may be caused in individuals who suffer from panic attacks. Such people may suffer from a rapid heartbeat, fear, sweating and dizziness and an urge to vomit. There may be associated fear and chest pain can often develop. In addition, such a person is often seen to be trembling and shaking. In some cases, these features can resemble a heart attack and that even tends to worsen the sense of terror associated with the situation. For these kinds of patients, who are often women, medications to relieve anxiety may be prescribed in addition to deploying the relevant kind of psychotherapy. Lastly, another chest condition that leads to pain is called costochondritis which is an inflammation of the cartilage in the ribs. The pain can start suddenly and get worse during the course of exercising, lying down, coughing or sneezing.
In the same way, an inflammation of the tendons and muscles around the ribs can lead to persistent chest pain. Usually, if the pain worsens with any form of physical activity, it may be due to a muscle strain. This occurs a lot in active young children and teenagers. We should add here that injuries to the ribs either from bruises, blunt trauma and fractures will usually cause chest pain. The patient may have heard an obvious crack at the time of the injury or felt a sharp chest pain. The cause of such pain is usually obvious. The associated factors are an inability to breathe in deeply and abnormal movement seen on the chest wall. Lastly, there is significant pain and discomfort in the chest which sometimes extents to the back. It is important to recognize the fact that problems within the heart can often lead to chest pain and one of these problems has to do with a heart attack which we discussed on this page about 6 years ago. Usually, there is pain in the jaw, neck and chest which may extent to the back. There may be pain in the arms and shoulders and there is often associated difficulty with breathing. Also among common heart conditions is the development of angina which usually feels like a squeezing pain or pressure on the chest. This condition occurs when there is inadequate supply of blood to a segment of the heart with the implication, of course, that not enough oxygen is being supplied. Somebody like that may also feel pain in the back, neck, arms and jaw. In the concluding part of this important topic, we shall be examining those factors within the abdomen that can also cause chest pain.
