Chest Tightness

Introduction

The sensation of chest tightness can naturally be a concerning symptom, as it raises the possibility of a problem with the heart or specifically a heart attack. However, a variety of conditions, aside from heart disease, can cause you to feel chest pain and determining which of these is responsible for your symptoms requires clinical experience and, often, objective testing.

If you are suffering from chest pain, seeking the help of an experienced heart specialist will help you to receive timely treatment for heart disease, if this is the cause, or provide valuable piece of mind and relief from anxiety.

Causes

• Heart-related causes

If the heart is not receiving enough blood for the work it is doing, this results in discomfort, in the same manner that any other muscle would hurt if not receiving enough blood. Chest pain from the heart is therefore often felt on exertion, when the heart is working its hardest. This is typically due to blockages within the arteries supplying the heart, with the feeling of a tight chest due to this condition occurring on exertion and relieved with rest. If the heart isn’t receiving enough blood for its needs at rest or on minimal exertion, this is termed unstable angina. When this is severe enough to cause damage to the heart muscle, this defines a heart attack.

Another common heart-related cause of chest pain is pericarditis. This is inflammation of the lining in which the heart is encased. Typically, chest pain due to pericarditis is a sharp pain, worse on breathing in and when lying flat. Chest pain associated with a heart murmur may be a symptom of a heart condition requiring medical attention.

• Lung-related causes

Several lung conditions can result in chest pain, including pulmonary embolism (blockage of the arteries supplying your lungs), pneumonia and pleurisy. Typically, lung pain is felt as a sharp pain, worse on breathing in.

• Digestive-related causes

It can sometimes be very difficult to tell the difference between chest pain due to a heart problem and chest pain due to indigestion. Gastro-oesophageal reflux disease (GORD) is due to reflux of acid into the oesophagus (food pipe or gullet) and is felt as a central, burning pain or tightness.

• Anxiety and stress-related causes

Anxiety and stress can both result in chest discomfort. Most commonly, this occurs due to the surge of adrenaline associated with a panic attack, resulting in a tight feeling in the chest. If you have never suffered from anxiety attacks previously, it is very common to mistake these symptoms for a heart attack, as they are frequently accompanied by shortness of breath, palpitation, lightheadedness and an overwhelming feeling of impending doom.

Short- and long-term emotional stress can also result in chest pain due to strain on the muscles and joints in the chest wall, in particular the intercostal muscles.

• Muscle-related causes

Chest pain due to strain on the muscles between the ribs (intercostal muscles) can be caused by over-stretching, contact injury, repetitive forceful movement or not warming up before exercise. The best treatment for a muscle strain is “RICE” (Rest, Ice, Compression, Elevation).

Inflammation of the joints between the ribs and sternum (breastbone) can also cause an individual to feel severe chest pain and is often mistaken for a heart attack. This condition, costochondritis, usually settles with a course of anti-inflammatory medication.

Diagnosis

Dr Jordan will firstly try to determine the cause of your chest pain by taking a detailed history of your symptoms and performing an examination. He may then suggest blood tests, a chest x-ray and/or a specific test of the arteries supplying your heart, in order to determine the cause of your symptoms.

As Dr Jordan is an expert in cardiovascular imaging, he will almost always select a non-invasive diagnostic test (such as a CT, ultrasound or MRI scan), rather than an invasive angiogram in the first instance, in-keeping with current national and international guidelines for the diagnosis of heart conditions.

Treatment

Treatment of your symptoms depends on the underlying cause. If your chest pain is due to a blockage in the arteries supplying your heart, this needs prompt treatment, in order to prevent a heart attack. This treatment involves medication and sometimes a physical treatment (such as a stent) in order to unblock an artery.

Prevention

The key components of preventing chest discomfort due to heart disease are stopping smoking, maintaining a healthy diet and ensuring that you are exercising regularly. Effective treatment of predisposing health conditions: high blood pressure, raised cholesterol and diabetes, can help prevent you from developing chest tightness due to coronary artery disease in the future.

When to Seek Emergency Medical Care?

You should seek the advice of a medical professional, such as Dr Jordan, if you feel your chest discomfort could be due to your heart.

In particular, if your discomfort is felt at rest and your symptoms in-keeping with a heart attack, you should phone the emergency services without delay.

Conclusion

The sensation of a heavy chest or discomfort within your chest has many potential causes. Foremost amongst these is coronary artery disease, or blockages within the arteries supplying your heart. If you feel that you may have symptoms due to coronary artery disease, it is important that you seek the advice of a medical professional in a timely fashion so that you can receive the appropriate treatment.

You may be interested in reading other heart condition: Heart Murmurs