Chest Pain

Chest pain can be caused by a number of problems. These may involve the four main structures that lie within the chest–the lungs, the heart, the esophagus, and the chest wall (consisting of the ribs, muscles, and skin).

Angina: Chest Pain Caused by Low Blood Flow to the Heart

Cardiac chest pain (angina) is most often seen in men over age 45 or post-menopausal woman who have one or more of the following risk factors: a family history of early heart disease, smoking, diabetes, high cholesterol, high blood pressure, and obesity. Angina is caused when the heart’s demand for oxygen cannot be met because of narrow, clogged arteries. It would be the equivalent of blocking the blood flow to your leg with a tight rope and then going for a jog-you can imagine what that would feel like! This pain is usually described as a squeezing or pressure in the mid-portion of the chest, often accompanied by sweating, nausea, and/or left arm, hand, or jaw heaviness or discomfort.

Other important, yet less frequent symptoms may include sudden difficulty breathing, pain that radiates to the back between the shoulder blades, or indigestion that is not relieved with antacids or ulcer medicines. (Many long-term diabetics have developed a nerve disorder that makes it difficult to feel angina pain. Instead, when they are experiencing decreased blood flow to the heart, they often feel suddenly fatigued, dizzy, or short of breath.) If you think your chest pain may be angina, you likely fit one of these profiles and have one or more of the major cardiac risk factors listed above. If you don’t, consider another cause of your chest pain. If you experience what you think might be angina, see a doctor immediately as you may actually be having a heart attack or your symptoms may be a warning sign of an impending heart attack. If help is on the way and you are experiencing angina, take an aspirin and a nitroglycerine tablet, use oxygen (if available), limit your activity, and relax. (See Coronary Artery Disease.)

Emergency Care:

In Mexico, advanced services for treating life-threatening heart disease are present only in the major metropolitan centers we have identified in the Mexico: Health and Safety Travel Guide. If you have a history of heart disease or major risk factors for heart disease, visit your home-based doctor for a consultation and evaluation prior to traveling to areas where advanced cardiac services are not available. “

Indigestion: Chest Pain Caused by Irritation of the Esophagus

Acid from the stomach sometimes enters the esophagus and causes a burning sensation in the chest known as Gastro-Esophageal Reflux Disease (GERD). Pain from GERD typically occurs after a meal or after lying down, starts in the lower chest and may travel up to the center of the chest. Certain foods, substances, or conditions may predispose you to GERD. Anyone with a hiatal hernia may suffer from excessive indigestion. Foods that cause GERD include chocolate, alcohol, caffeine, tobacco products, fatty foods, aspirin and Ibuprofen, and citrus fruits and tomatoes. GERD is usually treated with prescription, antacid medicines such as cimetidine (Zantac), ranitadine (Tagamet), and omeprazole (Prilosec). You can often achieve immediate relief with over-the-counter antacids.

Treatment:

The best way to manage GERD is to avoid the above-mentioned foods and substances, never lie down within three hours after a meal, and to use antacid medicines when indicated. It may also be helpful to avoid clothing that constricts the abdomen. Finally, indigestion or chest pain that is not relieved with antacids may in fact be angina (see above); in this case, seek medical attention immediately.

Pain Related to the Chest Wall

Muscular chest wall pain (Chostochondritis) commonly occurs in young men and women. This pain is the result of overusing or straining the chest wall muscles (as with vigorous exercise). When pain accompanies torso and chest wall movements, you may have chostochondritis.

Here’s a test: if you can reproduce the pain when you press down on the muscles and ribs, you likely have chostochondritis. To treat this condition, rest the involved area, apply ice daily, and take non-steroidal anti-inflammatory (NSAID) medications such as Ibuprofen or Naprosyn. (See Anti-inflammatory medications for medication guidelines.) Or you can take acetominophen (Tylenol). If you have a significant history of trauma, you may have a rib fracture and should consult a physician.

Chest Pain Caused by Lung Disorders

Many lung processes can cause chest pain, most of which are beyond the scope of this guide. However, we will provide a brief overview of the signs and symptoms that would warrant you to seek medical attention.

If you experience sudden onset chest pain that is worse with breathing or coughing or is associated with shortness of breath or coughing up blood, you may have a serious condition and should seek immediate medical attention. If your chest pain is accompanied with fever, chills, shakes, or nausea and/or vomiting, you may have pneumonia or a bronchitis flare. In both cases, seek medical attention.