One of the most common symptoms that make people seek medical attention is chest pain.
This is pain or discomfort originating from or radiating to the chest. It could be mild to severe in nature. How it feels varies too. Sometimes it can be a sharp or stabbing pain or a dull aching pain.
It can also feel like a tightness or squeezing of the chest, burning sensation, heaviness, crushing, tearing, pressure or even mild discomfort.
Chest pain can be an indication of a life-threatening problem. It is advisable to consult your physician when you experience chest pain especially when it reoccurs or persist.
In this article, we’ll focus on recurrent chest pain, explaining the many possible causes.
Causes Of Chest Pain That Comes And Goes
Chest pain that comes and goes can be described as “recurring chest pain”. This pain presents for a few minutes then disappears either by relaxing or the use of medications.
Generally, chest pain is a symptom of problems relating to the cardiovascular system (heart), respiratory system (lungs), digestive system or musculoskeletal system. At this point, it should be noted that not every chest pain is heart-related or a heart attack.
1. Panic Attack:
Panic attack experienced in periods of intense fear is usually accompanied by chest pain which resembles a heart attack. There is an 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 by tightening in the chest sometimes.
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.
3. Gastroesophageal Reflux Disease (GERD):
GERD presents with a burning sensation in the middle or one side of the chest. This sensation is usually described as heartburn.
It occurs when stomach content moves back into the lower end of the throat. It occurs after meals and may be related to the body’s 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 heartburn. It neutralizes stomach acid. More potent medications like H-2 blockers and proton pump inhibitors can be used if symptoms persist.
4. Peptic Ulcer:
Pain from a peptic ulcer is usually located in the upper center of the abdomen known as the epigastric area but may radiate to the center of the chest presenting like heartburn. Its treatment involves using medications to reduce acid production and antibiotics.
5. Hiatal Hernia:
This occurs when the upper part of the stomach bulges out of a small opening in the diaphragm (a flat sheet of muscle that separates your chest from your abdomen, it helps you breathe).
Its symptoms include heartburn, chest pain, regurgitation and difficulty swallowing. Surgery is done to correct the hernia.
6. 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.
7. Gallbladder Problems:
Chest pain experienced after eating a fatty meal is an indication of a 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 the gallbladder. If the pain persists after the use of cholesterol medications, the gallbladder may be removed to prevent further pain.
8. Ischemic Heart Disease (IHD):
In this condition, there is a reduction of blood flow to the heart muscles. The reduced blood flow from the partial or complete blockage of the 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).
9. Coronary Artery Disease:
CAD happens when the coronary arteries- the arteries that supply the 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 the blood vessels supplying the heart. It limits the rate of blood flow into the heart, subsequently resulting in a reduction of oxygen.
This can be treated with medications like blood thinners, beta blockers, calcium channel blockers, statins, and surgery.
10. 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 the coronary artery. The chest pain is not induced by exertion but may awaken a person from sleep. It could be triggered by emotional stress too.
Nitrates and calcium channel blockers can be used to relieve it.
11. Aortic Valve Stenosis:
It is the narrowing of the aortic valve opening. This valve is a gate in form of leaflets that control the flow of blood from the left ventricle of the heart to the aorta- the big vessel that carries oxygenated blood from the heart to the 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.
12. Hypertrophic Cardiomyopathy:
This is a genetic disease that causes the walls of the heart’s ventricles (usually the left ventricle) to thicken. These thickened walls may stiffen putting more workload on heart ventricles to pump out blood.
It may also reduce the volume size of the ventricle chamber and may block the flow of blood out of the 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.
12. Mitral Valve Prolapse:
It is a condition where the mitral valve (the valve between the left atrium and left ventricle) does not close properly but it bulges into the left atrium, leading to a backflow of blood into the atrium. In most cases, it is asymptomatic but may present with chest pain, palpitation, and dizziness.
If the symptoms are severe, beta blockers can be used or a mitral valve repair must be done to relieve symptoms.
13. Pulmonary Hypertension:
It is a rare high blood pressure affecting the arteries of the lungs and the right side of the heart. In this condition, the small arteries that supply the lungs are narrowed or occluded making it harder for blood to flow into the lungs.
This narrowing or occlusion raises the pressure in the lungs’ arteries, resulting to increase in workload on the right ventricle in order for blood to be pumped out into the 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 the ankles, legs and eventually abdomen and in severe cases, cyanosis.
Antihypertensive drugs can be used to relieve 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, the immune system can cause the airway to be inflamed during exposure to irritants leading to tightness in the chest. It may also be accompanied by shortness of breath, difficulty breathing, wheezing, and cough. Chest tightness is relieved once the asthma is treated.
15. Muscle Pain
Pain in the chest can be from the muscles in that area. The pain may be sharp and worse on sudden inhalation. It usually goes away after some time.
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.
It is advisable to consult your physician when you experience chest pain especially when it reoccurs or persists.
- Fogoros, R. N. (2019, June 15). Chest Pain Caused by Anxiety or Panic Attacks. Retrieved June 18, 2019, from https://www.verywellhealth.com/chest-pain-anxiety-or-panic-disorder-1745280
- Aroesty, J. M., MD, & Kannam, J. P., MD. (2018, August 27). Patient education: Chest pain (Beyond the Basics). Retrieved June 18, 2019, from https://www.uptodate.com/contents/chest-pain-beyond-the-basics
- Non-Cardiac Chest Pain: GERD. (n.d.). Retrieved June 18, 2019, from https://my.clevelandclinic.org/health/diseases/15851-gerd-non-cardiac-chest-pain
- Non-cardiac Chest Pain. (2009, February). Retrieved June 18, 2019, from https://gi.org/topics/non-cardiac-chest-pain/
- Angina Pectoris (Stable Angina). (2015, July 31). Retrieved June 18, 2019, from https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/angina-pectoris-stable-angina
- Heartburn or heart attack: When to worry. (2017, June 07). Retrieved June 18, 2019, from https://www.mayoclinic.org/diseases-conditions/heartburn/in-depth/heartburn-gerd/art-20046483
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