Chiropractors treat a lot of chest pain – it doesn’t have to mean you are having a heart attack! Chest pain should not be ignored, however, but before you panic, bear in mind that there are many different causes. In fact, as much as a quarter of the population experiences chest pain that is not related to the heart at all. Deciding the cause of chest pain is sometimes very difficult and may require blood tests, X-rays, CT scans and other tests to sort out the diagnosis. Often though, a careful history taken by the health care professional may be all that is needed to find the answer.
What are potential sources of chest pain?
The following anatomic locations can all be potential sources of chest pain:
- the chest wall including the ribs, the muscles, and the skin;
- the back including the spine, the nerves, and the back muscles;
- the lung, the pleura (the lining of the lung), or the trachea;
- the heart including the pericardium (the sac that surrounds the heart);
- the aorta;
- the esophagus;
- the diaphragm, the flat muscle that separates the chest and abdominal cavities; and
- referred pain from the abdominal cavity including organs like the stomach, gallbladder, and pancreas, as well as irritation from the underside of the diaphragm due to infection, bleeding or other types of fluid.
If you have unexplained chest pain, the only way to confirm its cause is to have a chiropractor or doctor evaluate you. You may feel chest pain anywhere from your neck to your upper abdomen. Depending on its cause, chest pain may be:
- A tight, squeezing, or crushing sensation
Here are some of the more common causes of chest pain.
- Muscular or Rib Problems
If you over reach, pull or push something too heavy, cough severely over a prolonged period, you can sprain a rib or strain the muscles between the ribs. The pain you will experience can be sharp, usually on movement, or stabbing and you may feel pain in the rib on deep breathing. The main thing is that the pain you are experiencing can be reproduced by movement on examination. If not then you are unlikely to have pain due to a musculoskeletal cause. We will advise you if we think you need to seek advice elsewhere.
- Chest Pain Causes: Heart Problems
Although not the only cause of chest pain, these heart problems are common causes.
What is angina?
A blockage in the heart blood vessels that reduces blood flow and oxygen to the heart muscle itself, causing pain but not permanent damage to the heart. The chest pain may spread to your arm, shoulder, jaw, or back. It may go to the left arm but also to the right arm. It may feel like a pressure or squeezing sensation. Chest pain from angina can be triggered by exercise, eating, excitement, or emotional distress and is relieved by rest.
What is myocardial infarction (heart attack). This reduction in blood flow through heart blood vessels is more severe and causes the death of heart muscle cells. Though similar to angina chest pain, a heart attack is usually a more severe, crushing pain and is not relieved by rest. Sweating, nausea or severe weakness may accompany the pain.
What is myocarditis It is when heart muscle inflammation occurs and may cause fever, fatigue and breathing problems. Although no blockage exists, myocarditis symptoms can resemble those of a heart attack.
What is pericarditis. This is an inflammation or infection of the sac around the heart. It can cause pain similar to that caused by angina. However, it often causes a sharp, steady pain along the upper neck and shoulder muscle. Sometimes it gets worse when you breathe, swallow food, or lie on your back.
What is hypertrophic cardiomyopathy. Also called heart failure this occurs when the heart muscle becomes thickened. This makes the heart work harder to pump blood. Along with chest pain, this type of cardiomyopathy may cause you to be dizzy, lightheaded and experience shortness of breath, and other symptoms.
What is mitral valve and aortic valve prolapse. Mitral valve prolapse or aortic valve failure are conditions in which a valve in the heart fails to close properly. You may be born with a bicuspid valve instead of a tricuspid valve in the aortic valve or more rarely a unicuspid valve. The valve will struggle over the years to push the blood around the body and eventually calcification will occur and the valve will not be able to stop back flow of blood and reduction of blood to the body. This is what happened to Dr Krir in the aortic valve. A variety of symptoms have been associated with mitral valve prolapse, including chest pain, palpitations, and dizziness, although it can also have no symptoms for many years, especially if the prolapse is mild.
What is coronary artery dissection. A variety of factors can cause this rare condition, which results when a tear develops in the coronary artery. It may cause a sudden severe pain with a tearing or ripping sensation that goes up into the neck, back, or abdomen.
- Oesophageal Problems
The esophagus is a muscular tube that transports food from the mouth to the stomach. Reflux or GER The valve between the oesophagus and the stomach does not close properly and acid from the stomach leaks back up into the oesophagus. The lining of the oesophagus is not made to deal with acid of this strength and you will experience pain where it is irritated. Barrett’s esophagus A condition that occurs when cells in the lining of the oesophagus are damaged, usually because of exposure to acid from the stomach. This can happen as a complication of many years of suffering from gastroesophageal reflux (GER, commonly known as heartburn). It is estimated 1 percent of adults in the United Kingdom have Barrett’s oesophagus. The abnormal cells caused by Barrett’s oesophagus can become cancerous in some cases, though this is rare. Barrett’s oesophagus itself does not have any symptoms and most of the symptoms that you may experience are related to the acid reflux that sometimes occurs. Some symptoms of acid reflux include chest pain, abdominal pain as well as a dry cough. You may also experience difficulty with swallowing and frequent heartburn.
- Panic Attacks and Panic Disorder
Panic disorder can occur when you live in fear of having a panic attack. You are having a panic attack when you feel sudden, overwhelming terror that has no obvious cause. You may experience physical symptoms such as a racing heart, breathing difficulties, and sweating. Most people experience a panic attack once or twice in their lives. Panic disorder is characterized by constantly being afraid of having another panic attack after you experience one or having recurring (four or more) panic attacks. Even though the symptoms of this disorder can be quite overwhelming and frightening, they can be managed and improved with treatment. Seeking treatment is the most important part of reducing symptoms and improving your quality of life. The causes of panic disorder are not clearly understood. Research has shown that panic disorder may be genetically linked. Panic disorder is also associated with significant transitions that occur in life. Leaving for college, getting married, or having your first child are all major life transitions that may create stress and lead to the development of panic disorder. Cognitive Behavioural Therapy can be helpful.
The aorta carries blood from your heart to the body. Over 65’s may develop a ballooning of this vessel. This may be harmless if it is slow to develop but it could be serious and if you are over 65 it is recommended that you visit your GP to arrange an abdominal aortic aneurism ultrasound scan.
Shingles is a virus in a nerve, which manifests itself on the skin as painful blisters that follow the route of the affected nerve. I have seen many patients who have chest pain and who have shingles – if it starts in the back, it is difficult for you to see that you have blisters and these don’t develop until a while after you have had the virus – hence seeing a chiropractor can help you if you have shingles. We can’t help you but we can diagnose it!
The bottom line is, please don’t ignore chest pain – I did and it did me no favours – it might be nothing more than indigestion but don’t try to guess yourself – come to see us or go to your GP first but please check it out – it’s not ‘normal’ to have chest pain!