CHEST PAIN

There is very little parallel between the severity of chest pain and the seriousness of its cause. A frequent problem exists in distinguishing trivial disorders from coronary artery disease or other serious health hazards. It is important to avoid the long tradition now shown to be myth, that pain beneath the left breast or radiating into the left arm is always of cardiac origin.
Such pain is often observed in patients who are tense, easily fatigued, or anxious.
Oxygen deficiency of the heart muscle can produce pain. This is the syndrome medically termed angina pectoris. When the oxygen supply is deficient in relation to the need, pain will develop in the heart muscle. This may be aggravated by exercise, or occur during a stressful situation, or after a heavy meal. Atherosclerosis (narrowing) of the coronary arteries is the most common cause. Spasms of the small cardiac vessels may also trigger this pain (angina), which usually subsides with a short rest.
Pain in the esophagus usually results from acid irritation of the lining (mucous membrane) of the esophagus. Spasm of the swallowing muscles or the presence of obstruction can also produce this deep chest pain. Accompanying symptoms of difficult swallowing, regurgitation, and weight loss direct attention to the esophagus. Pain in the pleura or the lining of the lung is very common. It results from stretching of the inflamed membrane and occurs in viral, as well as bacterial, pneumonia. Sometimes air in the chest cavity (pneumothorax) and tumors can mimic this type of pain. Inflammation of the outer covering of the heart (pericarditis) can also produce it. It is usually aggravated by coughing or deep breathing. Sometimes swallowing or a change in bodily position produces the same type of pain, Applications of moist heat and rest are important in the relief of these deeper pains.
Tension is also a common cause of chest wall pain. Usually the discomfort is experienced as a sense of tightness, sometimes called aching. It may occur on various occasions and in different areas of the chest, and is usually associated with fatigue or emotional strain. It is important to distinguish these and the above categories of chest pain from various abdominal problems,
some of which are described below.