One of the most common symptoms which adults seek medical consult or attention is chest pain. It is pain or discomfort originating or radiating to your chest. It could be mild to severe in nature.
Its presentation ranges from sharp or stabbing pain to a dull aching pain. Other forms which it can also present are tightness or squeezing of your chest, burning sensation, heaviness, crushing, tearing, pressure or even mild discomfort around your chest.
Location of chest pain varies from the right side, center to the left side of your chest. Sometimes, this pain can also radiate to your neck, jaws, shoulders, arms, and back. It can also present as recurrent episodes, that is chest pain that comes and goes.
Chest pain can be an indication of a life-threatening problem. There are different causes of chest pain and the most severe ones involve your cardiovascular or respiratory system.
Causes Of Chest Pain That Comes And Goes
Generally, chest pain is a symptom of problems relating to your cardiovascular system (heart), respiratory system (lungs), gastrointestinal system or musculoskeletal system. At this point, it should be noted that not every chest pain is heart-related or a heart attack.
Chest pain that comes and goes can be described as “recurring chest pain”. This pain presents for few minutes then it disappears either by relaxing or the use of medications.
The most typical chest pain that comes and goes arising from the cardiovascular system is called an “Angina.” It is a medical term used to describe chest pain resulting from the blockage of blood vessels carrying oxygen-rich blood (arteries) into the heart muscle.
It presents as tightness, pressure, heaviness, discomfort or squeezing at the center or across your chest. It may also present as indigestion. Sometimes, the pain can spread to your jaw, neck, arm or between your shoulders. It tends to last for a short time, it goes away and comes back.
Most times, It is triggered by physical or emotional stress. It usually worsens with activities and relieved by resting or the use of medications like Nitroglycerin. It is an artery relaxer in form of a tablet or a spray under the tongue. It relaxes the heart’s arteries, allowing blood to flow easily through the narrowed space.
There are four types of angina:
This is usually associated with physical exertion liking walking up a hill or climbing up the stairs. The pain doesn’t catch you as a surprise, it comes and goes. The pain lasts for few minutes (5 minutes or less). It subsided by resting or by using nitroglycerin.
This occurs when you are at rest or sleeping. It may last longer than stable angina. Rest or medications does not relieve it and may result in a heart attack. This needs urgent medical attention.
Variant or Prinzmetal angina:
It is a severe intermittent pain which occurs while you are resting or sleeping during the night or early hours of the day. It is less common than the others. It is seen in younger people and triggered by stress. It can be relieved with medications like calcium channel blockers and nitrates.
It occurs as spasms within the smallest coronary blood vessels. The chest pain is usually longer than stable angina (longer than 10 minutes). It can also be treated with calcium channel blockers and nitrates.
The following heart problems can cause chest pain that comes and goes:
1. Ischemic Heart Disease (IHD):
In this condition, there is a reduction of blood flow to your heart muscles. The reduced blood flow from the partial or complete blockage of your heart’s arteries leads to myocardial ischemia.
The major clinical presentation of IHD is angina. Although, other associated symptoms can include shortness of breath, dizziness, weakness, nausea, vomiting and cold sweats. IHD is often caused by coronary artery disease (CAD) or coronary heart disease (CHD).
2. Coronary Artery Disease:
CAD happens when the coronary arteries – the arteries that supply your heart muscles, are hardened and narrowed resulting from the accumulation of atherosclerotic plaque.
Atherosclerotic plaque is a buildup of cholesterol and other materials on the walls of your blood vessels supplying your heart. It limits the rate of blood flow into your heart, subsequently resulting in a reduction of oxygen to your heart.
This can be treated with medications like blood thinners, beta blockers, calcium channel blockers, statin, and surgery.
3. Coronary Vasospasm:
This can cause myocardial ischemia and eventually myocardial infarction (when the heart’s muscle cells die from reduction of blood and oxygen supply).
It is a smooth muscle constriction of your coronary artery. It presents as microvascular angina. The chest pain is not induced by exertion but may awaken you from sleep. It could be triggered by emotional stress.
Nitrates and calcium channel blockers can be used to relieve your chest pain.
4. Aortic Valve Stenosis:
It is the narrowing of your aortic valve opening. This valve is a gate in form of leaflets that control the flow of blood from the left ventricle of your heart to the aorta- the big vessel that carries oxygenated blood from your heart to your body.
This narrowing leads to restriction of blood flow leaving the heart. Most people with aortic valve stenosis do not experience noticeable symptoms until there is an increase in the restriction of blood flow. Symptoms presented are angina, breathlessness, fainting, palpitation and heart murmur.
Treatment depends on its severity. In severe cases, it requires surgical intervention by repairing or replacing the valve.
5. Hypertrophic Cardiomyopathy:
This is a genetic disease that causes the walls of your heart’s ventricles (usually the left ventricle) to thicken. These thickened walls may stiffen putting more workload on your heart ventricles to pump out blood.
It may also reduce the volume size of your ventricle chamber and may block the flow of blood out of your heart. Symptoms include chest pain and shortness of breath often occur with exercise, dizziness, lightheadedness, and fainting.
Treatment may include medications such as beta blockers and antihypertensive drugs or a pacemaker.
6. Mitral Valve Prolapse:
It is a condition where your mitral valve (the valve between your left atrium and left ventricle) does not close properly but it bulges into your left atrium, leading to backflow of blood into the atrium. In most cases, it is asymptomatic but may present with chest pain, palpitation, and dizziness.
You can live without treating this condition, however, if the symptoms are severe, beta blockers can be used or a mitral valve repair must be done to relieve symptoms.
1. Pulmonary Hypertension:
It is a rare high blood pressure affecting the arteries of your lungs and the right side of your heart. In this condition, the small arteries that supply your lungs are narrowed or occluded making it harder for blood to flow into the lungs.
This narrowing or occlusion raises the pressure in your lungs’ arteries, resulting to increase in workload on the right ventricle in order for blood to be pumped out into your lungs.
Its major clinical presentation is shortness of breath (dyspnea). Chest pain associated with pulmonary hypertension can be described as angina. Other symptoms include dizziness, fatigue, palpitations, swelling in your ankles, legs and eventually abdomen and in severe cases, cyanosis.
Antihypertensive drugs can be used to relieve your symptoms.
Chest tightness or pain is a typical symptom of asthma. It is described as a warning sign of an asthma attack. It can present before, during or after an asthma attack.
In asthma, your immune system can cause your airway to be inflamed during exposure to irritants leading to tightness in your chest. It may also be accompanied by shortness of breath, difficulty breathing, wheezing, and cough. Chest tightness is relieved once your inhaler is used.
1. Gastroesophageal Reflux Disease (GERD):
GERD presents with a burning sensation in the middle of the chest or one side of the chest moving towards the neck. This sensation is usually described as heartburn.
It occurs when stomach content moves back into the throat. It occurs after meals and may be related to body position. Episodes of pain can also be induced by bending over at the waist. Treatment of GERD will help relieve the chest pain.
Antacids can be used to treat your heartburn. It neutralizes your stomach acid. More potent medications like H2 blockers and proton pump inhibitors can be used if symptoms persist.
2. Peptic Ulcer:
Pain from peptic ulcer is usually located in your upper center abdomen known as the epigastric area but it may radiate to the center of your chest presenting like heartburn. Its treatment involves using medications to reduce the acid production and antibiotics.
3. Hiatal Hernia:
This occurs when the upper part of the stomach bulges out of the hiatus of your diaphragm (a small opening on your diaphragm for the passage of your esophagus before connecting with your stomach).
Its symptoms include heartburn, chest pain, regurgitation and difficulty swallowing. Surgery is done to correct the hernia.
4. Esophageal Spasm:
It is the irregular, uncoordinated contraction of the esophagus when food moves through it. This present as severe chest pain that comes and goes on swallowing.
Treatment for esophageal spasm includes treating other conditions that may make esophageal spasms worse, such as GERD.
5. Gallbladder Problems:
Chest pain experienced after eating a fatty meal is an indication of gallbladder problem. In mild cases, the pain goes away after some minutes but may persist like a heart attack in severe cases.
Most of the time, it is due to gallstones present in your gallbladder. If the pain persists after the use of cholesterol medications, your gallbladder may be removed to prevent further pain.
Intermittent Chest Pain From Other Problems.
1. Panic attack:
Panic attack experienced in the periods of intense fear is usually accompanied by chest pain which resembles a heart attack. There is associated rapid breathing, increased heartbeat, profuse sweating, shortness of breath, dizziness, and fear of dying.
The chest pain disappears after the panic attack, usually by relaxing and deep breathing.
You may experience chest pain when you are anxious. The body responds to anxiety in form of tightening in the chest.
Chest pain may be sharp, heavy, tighten or burning in nature. It is located all over the chest area. It is relieved by resting or taking deep breaths.
Not all chest pain that comes and goes is heart-related as there are other possible causes. It may range from a mild episode from anxiety to a more severe problem.
There are other medical problems which present with chest pain, but the pain does not come and go. It may be severe, persistent and can be life-threatening. Chest pain from myocardial infarction or a heart attack cannot be categorized into the chest pain that comes and goes because it is an emergency and requires an immediate medical attention.
In myocardial infarction (MI) or heart attack, the reduction of blood flow in the blood vessels leads to the death of your heart muscle cells. The chest pain may present as angina but most times, it presents as a crushing pain which you are unable to pinpoint its location. Maybe felt at the center of the chest or across the chest. It usually lasts longer and It is not relieved by rest or medications.
It is advisable to consult your physician when you experience chest pain especially when it reoccurs or persist.
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