Chronic Chest Pain

Assesment of chest pain

Common Causes
• Acute Coronary Syndrome
• Stable Angina
• Pulmonary embolism
• Pnumonia
• Viral pleuritis
• GORD
• Costochondritis
• Anxity or panic disorder

Uncommon Causes
• Pericarditis
• Cardiac temponade
• Aortic dissection
• Aortic stenosis
• Mitral valve prolapse
• Pnumothorax
• Pulmonary hypertension
• Peptic ulser desease(PUD)

Angina

Like any other muscle in the body, the heart (coronary) muscle needs a good blood supply. The coronary arteries supply blood to the heart muscle. Angina is a pain that comes from the heart. It is usually caused by narrowing of the coronary arteries. This narrowing causes a reduced blood supply to part, or parts, of the heart muscle.

Heart attack (myocardial infarction)

During a heart attack, a coronary artery or one of its smaller branches is suddenly blocked. This means that the part of the heart muscle supplied by this artery loses its blood and oxygen supply. Unless the blockage is quickly removed, this part of the heart muscle is at risk of dying.

Gastro-oesophageal reflux disease

This is a general term which describes a range of situations including:
• Acid reflux - when acid leaks up (refluxes) from the stomach into the gullet (oesophagus).
• Oesophagitis - when there is inflammation of the lining of the oesophagus. This inflammation is due to irritation of the lining caused by the reflux of stomach acid.

Costochondritis

The rib cage is a bony structure that protects the lungs inside. Bones are hard and solid and so don't tend to bend or move. However, the rib cage needs to move as our lungs expand when we take in a breath during breathing. Cartilage is a softer and more flexible material that is found in joints around the body. Cartilage attaches the ribs to the breastbone (sternum) and the sternum to the collar bones (clavicles). This means that the rib cage is able to move during breathing. The joints between each rib and the cartilages are called the costochondral joints. The joints between the cartilages and the sternum are called the costosternal joints. The joints between the sternum and the clavicles are called the costoclavicular joints.

In costochondritis, there is inflammation in either the costochondral, the costosternal or the costoclavicular joints (or a combination). Costochondritis causes chest pain, felt at the front of the chest. The pain is typically sharp and stabbing and is worse with movement, exertion and deep breathing. Pressure over the affected area also causes sharp pain. The pain is usually confined to a small area but it can spread (radiate) to a wider area. The most common sites of pain are close to the sternum at the level of the 4th, 5th and 6th ribs

Strained chest wall muscle

There are various muscles that run around and between the ribs to help the rib cage to move during breathing. These muscles can sometimes be strained and can lead to chest pain in that area. If a muscle is strained, there has been stretching or tearing of muscle fibres, often because the muscle has been stretched beyond its limits. For example, a strained chest wall muscle may sometimes develop after heavy lifting, stretching, sudden movement or lengthy (prolonged) coughing. The chest pain is usually worse on movement and on breathing in.

Post Cardiac Surgery Pain

Chronic pain occurs in 40–50% patients following cardiac surgery. Dysaesthesia, either in the form of heightened or diminished skin sensation, are frequently associated with chronic neuropathic pain.

Anxiety

Anxiety is quite a common cause of chest pain. As well as feeling fearful, worried and tense, anxiety can sometimes cause physical symptoms including chest pain.