Chest Pain & Discomfort

See also Breathing Pain for more lung orientated disorders

Angina
General tight, band like, crushing pain felt across the front of the chest. It is generally brought on by exertion and relieved within 5 minutes of rest or after taking trinitrin.
Angina pain occurs when the heart muscle is starved for oxygen generally caused by narrowing of the coronary arteries. The pain has also been known to start as chest pain and radiate towards the jaw or down into the left or both arms. If the chest pain lasts longer than 20 minutes it is most likely due to myocardial infarction.
Types of Angina
Decubitus Angina
Chest pain when laying flat, generally appears with myocardial ischaemia

Nocturnal Angina
Chest pains which awaken the individual while sleeping

Acute Coronary Insufficiency Angina
Severe chest pain suggesting myocardial infarction but without any investigatory confirmation of infarction.

Unstable Angina
Chest pain that has become significantly worse within the previous 4 weeks (approximately). It may have started as stable angina but progressed to this unstable state. Generally in this progressed state Trinitrin does not relieve the angina chest pains.

Crescendo Angina
Chest pain which slowly increases in frequency and severity over a very short period of time. It is usually a pre-infarctive condition.

Aortic Dissection
Severe and tearing pain located in the chest or in the abdomen depending on where in the aorta the tearing is situated. Dissections occurs when there is a tear in the innermost layer of the arterial wall. Blood will dissect the vessel wall into two layers interfering with normal blood flow. Organs post dissection may lack blood creating an infarction in those organs creating other symptoms besides the extreme pain.

Myocardial Infarction
Sudden Chest pain which is severe in nature and often described as a heavy and tight pain (vice-like pain). People have described the pain as “if an elephant was standing on my chest”. A general concomitant symptom is whole body profuse sweating. The chest pain in myocardial infarctions are similar to that of angina pain but the pain will not be relieved by trinitrin, rest and will last in excess of 20 minutes. In myocardial infarction the patient may also feel shortness of breath and light headed ness and the patient may also collapse. In some cases the pains are thought to be digestive instead of cardiovascular while in some other cases there may not be pain, a “painless” heart attack.
The pain of a myocardial infarction is caused by the lack of oxygen and nutrients provided to the heart via the blood stream. This inadequate oxygenation of the heart muscle causes heart cell death or “necrosis”.

Pericarditis
Sudden sharp chest pain mimicking the same symptoms of a myocardial infarction or angina. The chest pain my be affected by breathing and may persist for several days and may recur. Generally, pericarditis is presumed to have a viral cause and therefore show flu like symptoms prior to the attack.

Pleuritic Chest Pain
A sharp, stabbing, well-localized chest pain which is aggravated on deep inspiration. The pain is caused by an irritation of the outer pleura which becomes inflamed.

Superficial Chest pain
This type of chest pain has many causes and many types of pain. It can be sharp and localized as in shingles (along a nerve ganglia) or dull and continuous as in intrapulmonary malignancies. There are many types of pains and many diseases which may cause this type of pain.

Tracheal Pain
Generally tracheal chest pain is felt behind the sternum and miastinal pain may feel similar to cardiac pain. Tracheal pain is distinguished from cardiac pain in that it is not aggravated by exercise.

Reference:

Clinical History Taking and Examination
Second Edition – An Illustrated Colour Text
P.D. Welsby
Churchill Livingstone - 2002