Is chest pain a serious heart condition?
Chen Hui (Master’s student)
Chest pain is quite common in daily life, and many people habitually think that chest pain is the attack of coronary angina and that there is something wrong with the heart, this understanding is quite one-sided, according to statistics, only 15%-25% of the occurrence of chest pain is the attack of angina or acute heart attack. Li Song, Cardiovascular Disease Specialist, Guangdong Provincial Hospital of Traditional Chinese Medicine
With the modernization of the society and the aging of the population, the number of patients visiting the hospital for chest pain has a tendency to increase gradually. The clinical manifestations of chest pain vary, the conditions are highly variable, and the dangers differ greatly, and in most cases may indicate a serious adverse prognosis, such as acute coronary syndrome, aortic coarctation, and other high-risk diseases. The more serious the disease, the more time-dependent the prognosis, i.e., the earlier the diagnosis and the more timely the treatment, the better the prognosis, and vice versa, such as cardiogenic chest pain.
What is meant by chest pain?
Chest pain is a discomfort or pain between the neck and the upper abdomen. Chest pain is mainly caused by chest diseases, and a few are caused by other diseases. There are quite a few reasons why chest pain occurs, and the location and severity of chest pain does not always correspond to the location and severity of the lesion. Because of the simplicity of the public perception of chest pain and the complexity and variability of actual chest pain, it is necessary to reacquaint people with chest pain.
What are the causes of chest pain?
First, chest pain caused by cardiovascular origin.
1. heart diseases: coronary atherosclerotic heart disease (stable angina, acute coronary syndrome), mitral or aortic valve lesions, myocarditis and cardiomyopathy, acute pericarditis, etc.
2. vascular diseases: aortic coarctation, acute pulmonary embolism, etc.
Second, chest pain caused by non-cardiovascular origin.
1. lung and mediastinal diseases: tumors of the lung and mediastinum, pleurisy, pneumothorax, hemothorax, mediastinitis, mediastinal emphysema, etc.
2. digestive system diseases: esophageal reflux, esophagitis, esophageal cancer, esophageal hiatal hernia, peptic ulcer, gastritis, pancreatitis, subseptal abscess, liver abscess, splenic infarction, gallstones, cholecystitis, etc.
3. musculoskeletal diseases: costochondritis, trauma or strain, chest wall tumor, multiple bones, myeloma, compression or infiltration of nerves by leukemia.
4. Neurological diseases: intercostal neuritis and other compressive neuropathies.
5. Infectious: herpes zoster, chest wall soft tissue inflammation, epidemic chest pain.
6. Psychological diseases: anxiety or depression, panic attack or hysteria, cardiac neurosis, hyperventilation syndrome.
From the above introduction, we can understand that the diseases causing chest pain are quite extensive, therefore, the clinical manifestations of chest pain can be very different, we can see that the diseases causing chest pain such as acute coronary syndrome, aortic coarctation, pulmonary embolism, tension pneumothorax, etc. are life-threatening, of course, there are also those caused by emotional disorders like anxiety or depression, which are not life-threatening but also affect the quality of life These are not life-threatening but do affect the quality of life. Even our doctors take the symptom of chest pain quite seriously, so I suggest that patients need to pay enough attention if they have chest pain and other discomfort.
How to identify chest pain?
I. Judging from the location of chest pain
Chest pain caused by many diseases often has a certain location, and the location of chest pain helps to determine the cause of the disease. Such as.
1. chest pain caused by chest wall diseases is often fixed at the lesion site, and there is mostly obvious local pressure pain.
2. angina pectoris is often in the retrosternal or precordial region.
3. pain from esophageal disorders, septal hernia, and mediastinal tumors is also located behind the sternum.
4. spontaneous pneumothorax, acute pleurisy, pulmonary embolism, etc. often present severe chest pain on the affected side.
Second, the nature of chest pain to determine
The nature of chest pain can be various, and the degree can be severe, mild or vague.
1. Herpes zoster is a sharp pain like cutting or burning.
2. burning pain in esophagitis.
3. intercostal neuralgia with paroxysmal burning or stabbing pain.
4. angina pectoris with cramp-like pain and a feeling of heavy pressure and suffocation, and more intense pain and a feeling of fear and near death in myocardial infarction.
5. pneumothorax with tearing pain at the beginning of the attack.
6. pleurisy often presents with vague, dull and stabbing pains.
7. aortic coarctation is a sudden onset of severe tearing-like pain or cone pain in the back of the chest.
8. Pulmonary infarction can also occur suddenly with severe pain or colic in the chest, often accompanied by dyspnea, hemoptysis and cyanosis.
Third, judging from the time limit of pain
The duration of pain has a strong differential diagnostic value for chest pain, especially for the differentiation of myocardial ischemic chest pain and non-myocardial ischemic chest pain. Chest pain that lasts only momentarily or no more than 15 seconds does not support myocardial ischemic chest pain, but is more likely to be musculoskeletal neuropathic pain, pain from esophageal hiatal hernia, or functional pain. Chest pain lasting 2 to 10 minutes is more likely to be stable chest pain, while those lasting 10 to 30 minutes are more likely to be unstable angina pectoris. Chest pain that lasts more than 30 minutes or even hours can be acute myocardial infarction, pericarditis, aortic entrapment, herpes zoster, or bone pain, which are long lasting and not easily relieved in a short period of time.
It should be noted that chest pain that starts sharply and peaks rapidly often indicates rupture of thoracic organs, such as aortic coarctation, pneumothorax, mediastinal emphysema, etc.
4. Judging from the accompanying symptoms of chest pain
Accompanying symptoms of chest pain.
l Chest pain often accompanied by cough: caused by tracheal, bronchial and pleural diseases.
l Chest pain often accompanied by dysphagia: caused by esophageal and mediastinal diseases
l Chest pain often accompanied by hemoptysis: tuberculosis, pulmonary embolism, primary lung cancer
l chest pain often accompanied by deep inspiration or aggravated by sneezing: thoracic spine lesions
l chest pain often associated with a history of hypertension and/or coronary artery disease: angina pectoris, myocardial infarction
l Chest pain often accompanied by dyspnea: pneumonia, pneumothorax, pleurisy, pulmonary embolism, hyperventilation syndrome, etc.
V. Judging from the factors affecting chest pain
l Angina pectoris is often induced by exertion or nervousness, paroxysmal, and is rapidly relieved by taking nitroglycerin tablets; myocardial infarction is often persistent and severe, and is not relieved by taking nitroglycerin tablets
l Chest pain due to cardiac neurosis is often improved by exercise
Pleurisy, spontaneous pneumothorax, pericarditis chest pain is often aggravated by coughing or deep breathing
l chest pain due to chest wall diseases is often aggravated by local pressure or thoracic activity, and the pain is relieved by local anesthesia
l Chest pain from esophageal disease often attacks or worsens when swallowing food
l Pain due to posterior spinal nerve disorders is aggravated by turning
l hyperventilation syndrome, the chest pain can be relieved after the exhalation with a paper bag.
Sixth, judging from the age of onset
For chest pain in young adults, tuberculous pleurisy, spontaneous pneumothorax, myocarditis, cardiomyopathy, rheumatic heart valve disease should be considered, while angina pectoris, myocardial infarction and bronchopulmonary cancer should be paid attention to over 40 years old. Especially in middle-aged and elderly people, if chest pain occurs, it is often necessary to exclude coronary artery disease, and what is currently recognized as the gold standard is coronary angiography, which is of great significance for the diagnosis of chest pain suspected of coronary artery disease-like.
The above has described chest pain from various aspects, and I believe that you have a more accurate understanding of chest pain. From the many diseases involved in chest pain, there are so many diseases that can be life-threatening. Some patients who experience chest pain and other discomfort like to take their own medicine, which is not wrong, but often if the condition is relieved, it is easy to underestimate the condition and delay the treatment. Like nitroglycerin can relieve angina, but likewise, nitroglycerin can relieve spasm of the esophagus and bile duct. Thinking that chest pain is angina, and not going to the hospital when the pain is relieved, delays the treatment. Therefore, I suggest that if chest pain occurs, go to the hospital as soon as possible to rule out diseases that can be life-threatening.
What diseases cause chest pain that require adequate efforts in terms of daily regimen?
I. Gallstones and cholecystitis
From the above causes of chest pain, we can learn that gallstones and cholecystitis can surprisingly also cause chest pain. Although gallstones and cholecystitis more often cause right lower chest pain, some patients can have angina-like attacks, and such angina-like attacks can disappear with the removal of the gallbladder, which is called biliary heart syndrome. The pain of biliary tract disease mostly occurs after a high-fat diet, and the pain often radiates from the stomach and epigastric region to the right quarter rib and right shoulder, and some patients are accompanied by jaundice and fever.
Therefore, it is recommended that we pay attention to the diet in our daily life, and it is advisable to have a light diet, not to eat fatty, sweet, thick and greasy, and to overeat.
Second, cervical spondylosis
First of all, you may think: What does cervical spondylosis have to do with chest pain? There is. I once saw a patient who had chest pain, chest tightness, and shoulder and back pain after several days of exertion, and thought it might be coronary heart disease, so he took quick-acting heart pills and nitroglycerin, but the symptoms did not ease at all. When he couldn’t hold on, he came to the hospital and had a coronary angiogram, which didn’t reveal any abnormality. Finally, he had a cervical spine examination, such as cervical spine film and MRI, and it turned out to be a disease called “cervical heart syndrome”. After treatment with traditional Chinese medicine, together with rest and Chinese herbal medicine, the discomfort soon disappeared.
In cervical spondylosis-like coronary syndrome or cervicogenic pseudo-angina, the pain is caused by irritation of the posterior roots of the cervical spinal nerve without ECG changes, and the pain lasts for 10 minutes to a few hours, and nitroglycerin is ineffective.
In daily life, however, there are many things to note, such as the center of the pillow should be slightly concave during sleep, the height of 11-15 cm, the neck should be pillowed on the pillow, not suspended, so that the head is kept slightly back. Those who are used to side lying position, should make the pillow with the shoulder height. Do not lie down and read a book while sleeping, and do not put your hands above your head for a long time. Pay attention to rest, ambulatory work for more than an hour should be active cervical waist joints, or hot water shower, hot water bag bureau compress, thoroughly relax the muscles and mental state.
Normally, you can do cervical spine health exercises, through the relaxation of the neck in all directions of movement, active cervical spine area blood circulation, relax the neck ligament muscle, enhance the fatigue tolerance of the neck muscles. However, in the acute attack period, it is not advisable to increase the stimulation of sports, and it is even more contraindicated when there are more obvious or progressive spinal cord compression symptoms, especially cervical backward movement or over-extension and over-flexion movement, such as tilting the head to put aside things or drying clothes. For vertebral artery cervical spondylosis, the rotational movement of the neck should be gentle and slow, and the amplitude should be properly controlled.
Chinese medicine believes that cervical spondylosis is due to long-term strain on the neck, coupled with external wind, cold and dampness, resulting in the poor operation of qi and blood, meridians and closed obstruction, acupuncture and massage can harmonize qi and blood, dredge tendons and channels, to achieve the effect of relieving spasm and pain, so it is also a good and practical treatment method. Physical therapy can improve local blood circulation and relax spastic muscles. High frequency (microwave, ultra-short wave), low and medium frequency electrotherapy, ultrasound and magnetic therapy can be used at the onset. It should be noted that different massage and physical therapy methods have their own indications and contraindications. For example, massage therapy is not recommended for spinal cord cervical spondylosis because it may aggravate the damage to the spinal cord. Cervical traction is often used as the first choice for neurogenic, cervical and sympathetic cervical spondylosis, but it is not recommended for spinal cord cervical spondylosis with significant spinal cord compression or for those with significant cervical segmental instability. Therefore, it is recommended that patients choose appropriate self-care treatment methods under the guidance of a professional physician.
Third, cardiac neurosis
In the daily treatment of patients, we often encounter some patients who complain of chest pain, chest tightness, and panic, and think they are suffering from “heart disease” and come to the hospital with anxiety. However, most of them have normal X-ray, ECG and echocardiogram after examination. This is not organic heart disease, but a functional disorder of cardiac neurosis (i.e. cardiac phytonadic disorder) with cardiovascular symptoms.
The most common symptoms are palpitations, dyspnea, precordial pain and general weakness, as well as agitation, insomnia, excessive sweating, shivering, dizziness and dreaminess. Although the disease is not a life-threatening condition, it can be delayed from time to time, and in severe cases, the patient may not be able to live and work normally, which makes the patient suffer a lot.
Why does the heart have neurosis? Due to anxiety, tension, emotional excitement, trauma and other factors, the central excitation and inhibition processes become impaired, and the cardiovascular system regulated by the vegetative nerves is also disrupted, causing a series of symptoms of sympathetic hypertonia. In addition, overexertion, low physical activity, and lack of proper exercise of the circulatory system make it impossible to adapt to the slightest activity or exertion, thus producing an excessive cardiovascular response and causing the disease.
The main points that distinguish cardiac neurosis from typical angina pectoris are
l Patients are mostly young and middle-aged, with women being more common.
l The chest pain in this disease is mainly brief (a few seconds) stabbing pain or longer (several hours) vague pain, the patient sometimes feels stuffy or breathless, like gasping for one or two breaths, or sighing breathing, but there is no stuffy pain or more obvious pressure.
l chest pain mostly at the tip of the heart, under the breast, or often with shifting, little pain.
l symptoms appear mostly after fatigue, not at the time of labor or excitement, and recoil in comfort after making light physical activities.
l Nitroglycerin is ineffective, or only “”works”” in more than 10 minutes.
l The patient is easily agitated and may be accompanied by neurasthenia symptoms such as headache, vertigo, palpitations, fatigue, etc.
l Normal electrocardiogram and other tests.
l The diagnosis should be made on the basis of excluding organic chest pain.
Because there is no organic change in cardiac neurosis, the treatment is often based on psychotherapy. Patients themselves need to adjust their mindset, look directly at this disease and avoid avoiding avoiding medical treatment. You can go traveling, chatting and other ways to release their stress, but also can be combined with Chinese medicine, will be better results.
Fourth, the menopause syndrome
Menopause has a wide range of symptoms, one of which can also cause chest pain. Chest pain in menopausal women is mostly thought to be caused by endocrine dysfunction leading to plant nerve dysfunction, accompanied by paroxysmal hot flashes, sweating, with headache, dizziness, palpitations, nausea, etc.
According to Chinese medicine, menopausal women suffer from depletion of kidney essence, depletion of Tiankui, and low estrogen levels, resulting in imbalance in the function of the internal organs. Many of these symptoms are similar to coronary heart disease, such as chest pain and tightness. For kidney yin and yang deficiency, kidney qi pills are available, and for kidney yin deficiency, Liu Wei Di Huang Pills are available.
For food therapy.
1. 50 grams each of barley and japonica rice, 10 jujubes and 15 grams of licorice. Decoct licorice first, remove the dregs, then add japonica rice, barley and jujube and cook as porridge. Consume twice daily on an empty stomach. It has the effect of benefiting qi and tranquilizing the mind, calming the heart and improving the skin. It is suitable for women who are in a trance during menopause, often sad and crying, unable to control themselves or insomnia and night sweating, with red tongue and little coating and thin and counted pulse.
2. 30 grams each of lotus seeds, lily of the valley and japonica rice are cooked together and taken once a day in the morning and once in the evening. It is suitable for those with palpitation and sleeplessness, anxiety and forgetfulness, weakness of limbs and rough skin before and after menopause.
At the same time, it is necessary to strengthen the diet and eat more soy products, fresh vegetables and fruits.
V. Hyperventilation syndrome
Hyperventilation syndrome can also cause chest pain, chest tightness and other discomfort. So what is hyperventilation syndrome?
It is a physiological and psychological reaction caused by acute anxiety. During the attack, the patient will feel discomfort such as sweating, rapid heartbeat, palpitations and even chest pain, and speed up breathing because he cannot feel breathing, resulting in carbon dioxide being continuously expelled and the concentration being too low, causing symptoms such as secondary respiratory alkalosis.
The patient was a young woman with no previous history of heart disease, so she was given a mask to wear and after ten minutes, the chest pain and shortness of breath were basically relieved.