Chest Pain – Part 3 – still more types of chest pain?


By Julian Booker, MD

As much as I may not want to admit it, there are other things that can cause chest pain other than issues with your cardiovascular system. Most of these things annoy me because they don’t deal with the heart but I can’t deny that they are important. We will spend this post reviewing some of these other causes of chest pain.

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Now moving forward. Let’s try to cover some of the other causes of chest pain that may be important to you.

Pneumothorax

A pneumothorax occurs when a portion of the lung collapses. More importantly, air or gas fills the space between the lung and the chest wall. Typically a pneumothorax occurs following some sort of chest trauma although sometimes it can occur without any discernible precipitating injury. Conditions like COPD, pneumonia and people with various other lung diseases. The treatment for pneumothorax depends upon the size of the air leak. Smaller leaks are generally not terribly dangerous and will resolve on their own. Larger leaks can alter the pressures within the chest and inhibit blood flow into the heart. These large leaks require a special tube to drain the excess gas to allow the lung to heal. For patients with repeated leaks, special a special surgery may be required to prevent new pneumothoraces (pleural for pneumothorax).

How will you know if you have a pneumothorax? The symptoms associated with a pneumothorax are just like the others. The symptoms are sudden onset chest pain and shortness of breath. Like pulmonary embolism, the chest pain is isolated over the affected side of the chest. The pain usually is not pleuritic meaning it is not affected by deep breathing. In contrast to pericarditis, it is not really affected by body position.

Pneumonia

If you have a chest pain, cough, fever or hypothermia (low body temperature), chills, malaise (a general feeling of unwellness) or just feel sick then this one may be for you. Pneumonia occurs when infection sets within the lung tissue. The infection can be either because of a virus or bacteria. If you have pneumonia then antibiotics or antiviral medications are appropriate.

It is common to have pleuritic chest pain with pneumonia. Again, pleuritic chest pain is worse with deep breathing or cough. Wait…I have a fever and a cough with some chest pain…Do I have pneumonia? Probably not, but the only way to know for sure it to see your doctor. There are some factors that place you at higher risk.

  1. Age greater than 65
  2. COPD
  3. Chemotherapy or a weakened immune system
  4. Other major medical problems that may weaken your immune system such as liver failure or heart failure.

Pneumonia can be very severe and persons with pneumonia can deteriorate quickly.

Bronchitis

Whereas pneumonia is an infection of the lung tissue, bronchitis is inflammation/infection of the airways leading to the lung tissue. Bronchitis generally has less potential to make you sick compared to pneumonia but it can still be a bit much to deal with. The symptoms are very similar to pneumonia in that you can have pleuritic chest pain, productive cough, fever, malaise. Unlike pneumonia, bronchitis is generally only caused by viruses. Antiviral therapy is usually not required and antibiotics usually will not help. For most cases of bronchitis, following your grandmother’s instructions of drinking plenty of fluids and getting plenty of rest is most important. Sometimes antibiotics may be in order but your physician will help you make that decision.

Esophageal problems

This section will be short but it is well known that issues with your esophagus can lead to chest pain. Gastro-esophageal reflux disease (GERD) and esophageal spams or other motility disorders can lead to chest pain. The pain is described most like angina. Your symptoms of GERD can be brought on by eating certain foods like something spicy or they may wake you up at night. Unfortunately, heart disease can give very similar symptoms. The difference is that medicines to decrease stomach acidity will help alleviate your problems in the setting of GERD.

Musculoskeletal problems

There are a host of problems related to the muscles, ones and soft tissue that can give you pain in your chest. These problems often occur after too much physical activity. Often times you can point to the specific place where your pain is located. The pains are frequently associated with or exacerbated by moving or turning a specific way. The pains may last for several hours to days as opposed to angina which is generally felt to be much more short-lived. Sometimes these pains are pleuritic if the pleura (special lining of the lung and chest wall) or the intercostal muscles are involved. Non-steroidal anti-inflammatory medications like ibuprofen or naproxen tend to be very helpful with these pains. If you have any question as to whether your pains are related to muscles or something more dangerous, talk to a doctor or nurse as soon as possible.

So what have we learned?

  1. There are lots of causes for chest pain
  2. Most of the causes are not related to your heart but still dangerous nonetheless
  3. If you have any doubts as to the nature of your pain, find someone that can help you figure it out.

About Julian Booker, MD

I am a noninvasive cardiologist at the University of Alabama at Birmingham specializing in multi-modality cardiovascular imaging and preventative medicine. My training was primarily at Baylor College of Medicine in Houston TX and the National Institutes of Health in Bethesda MD.
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4 Responses to Chest Pain – Part 3 – still more types of chest pain?

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