Chest pain can be caused by many different conditions, some of which are minor and others more serious. Ongoing chest pain for months certainly warrants medical evaluation to determine the cause and appropriate treatment. Some common causes of chronic chest pain include heart disease, lung disease, GI issues like GERD, costochondritis, anxiety, and chest wall injuries. Diagnostic testing like EKG, chest x-ray, CT scan, cardiac stress testing, endoscopy, and lab tests can help pinpoint the origin of persistent chest discomfort. Treatment depends on the underlying condition but may include medications, surgery, or lifestyle changes. Don’t ignore chronic chest pain, as the consequences could be severe. Seeking proper medical care and following doctor’s orders can help resolve nagging chest symptoms and improve your quality of life.
What are the common causes of chronic chest pain?
Heart Conditions
Heart disease such as coronary artery disease, angina, or prior heart attack can cause recurring chest pain. This occurs when the heart isn’t getting enough blood and oxygen due to blockages or damage to the arteries and muscles of the heart. The pain may feel like pressure, squeezing, fullness or ache in the chest. It can radiate to the jaw, arms, or back. Exertion often triggers the pain, along with stress.
Lung Conditions
Lung diseases like chronic obstructive pulmonary disease (COPD), bronchitis, pneumonia, pleurisy, pulmonary hypertension or pulmonary embolism can also lead to persistent chest discomfort. The lungs become inflamed and struggle to expand fully when breathing. This causes chest tightness, pressure, or sharp pain, especially with deep breaths. Coughing up mucus or blood is common too.
GERD
Gastroesophageal reflux disease (GERD) results when stomach acid backs up into the esophagus due to a weak lower esophageal sphincter. This irritated the esophagus lining, causing symptoms of heartburn, chest pain, sore throat, hoarseness, and regurgitation. Lying down, eating certain foods, alcohol, and obesity can worsen GERD. The pain may mimic heart problems too.
Costochondritis
Costochondritis is inflammation where the ribs connect with the breastbone or sternum. It seems to be caused by injury, joint strain, or infection in the area. Sharp or aching chest wall pain results, which may be reproduced when pressing on the sore sternum. Costochondritis often resolves on its own, but anti-inflammatories and rest can help.
Anxiety
Anxiety and panic attacks produce many physical symptoms including chest tightness, pressure, and pain. This is the body’s response to a flood of stress hormones during excessive worry. Learning to control anxiety and managing stress through counseling, meditation, exercise or medication can provide relief.
What diagnostic tests confirm the cause of persistent chest discomfort?
Medical History and Physical Exam
The first step is always a thorough medical history and physical examination by a doctor. This helps identify risk factors and may point toward a probable cause. Heart, lung and abdomen are examined while asking about symptoms. Family history, smoking, exercise tolerance and previous illnesses are reviewed.
Blood Tests
Blood tests check for markers of heart damage like troponin levels. Other significant findings include high cholesterol, triglycerides, blood sugar, or electrolyte imbalances which may contribute to heart or lung problems. Tests for autoimmune diseases are done if costochondritis is suspected.
EKG
An electrocardiogram (EKG) records the heart’s electrical activity. It can detect irregular rhythms, inadequate blood flow and damage from prior heart attacks. EKG changes provide clues to the heart’s structure and function.
Chest X-Ray
A chest x-ray creates images of the lungs, heart, arteries and bones. It can identify lung infections, COPD, pneumonia, enlarged heart, thoracic aortic aneurysms, rib fractures or arthritis related to chest discomfort.
Stress Testing
Cardiac stress testing monitors EKG changes and cardiac symptoms while exercising on a treadmill or bike. Nuclear imaging scans show blood flow to the heart. Stress tests help diagnose coronary artery blockages limiting blood supply to the heart muscle.
CT Scan of Chest
A CT scan uses multiple x-rays to make detailed cross-sectional images of organs and tissues in the chest. It provides views of the lungs, heart, valves, coronary arteries, aorta, and structures within the chest cavity to pinpoint abnormalities.
Endoscopy
Upper endoscopy inserts a tiny camera on a tube down the throat to examine the esophagus, stomach and upper small intestine. This identifies ulcers, cancers, strictures, hiatal hernias contributing to GERD and subsequent chest discomfort.
| Diagnostic Test | Purpose |
|---|---|
| Medical history and physical exam | Identify risk factors and probable cause based on symptoms |
| Blood tests | Check for markers of heart damage, high cholesterol, diabetes |
| EKG | Records heart’s electrical activity to detect abnormalities |
| Chest x-ray | Create images of lungs, heart, arteries to spot problems |
| Stress testing | Monitors heart function during exertion to uncover blockages |
| CT scan of chest | Detailed views of organs and tissues in the chest cavity |
| Endoscopy | Views inside esophagus and stomach to identify GERD causes |
How are the common causes of chronic chest pain treated?
Heart Disease Treatment
– Medications – drugs to lower blood pressure, cholesterol, or reduce clotting are often prescribed. Nitroglycerin can relieve acute chest pain and open blocked arteries.
– Surgery – procedures like coronary artery bypass, stents or valve repair are done for severe blockages.
– Lifestyle changes – improving diet, exercising, stopping smoking and losing weight helps lower risk.
Lung Disease Treatment
– Bronchodilators and inhaled steroids open airways and reduce inflammation in lung diseases like asthma and COPD.
– Antibiotics treat bacterial lung infections.
– Supplemental oxygen increases oxygen delivery in advanced lung disease.
– Surgery may remove damaged lung tissue if medications aren’t sufficient.
GERD Treatment
– Diet and lifestyle changes prevent reflux – lose weight, avoid trigger foods, don’t eat before bed, sleep with head elevated.
– Antacids neutralize stomach acid and relieve symptoms.
– H2 blockers reduce acid production.
– Proton pump inhibitors more substantially lower stomach acid secretion.
– Surgery like Nissen fundoplication tightens the lower esophageal sphincter to limit reflux.
Costochondritis Treatment
– OTC anti-inflammatories (NSAIDs) alleviate swelling and pain at costosternal joints.
– Heat or cold packs can ease soreness.
– Rest allows chest wall to heal.
– Physical therapy improves mobility and function.
– Steroid injections directly reduce inflammation for severe cases.
Anxiety Treatment
– Counseling and cognitive behavioral therapy help develop coping skills for anxiety.
– Relaxation techniques like meditation lower stress.
– Exercise boosts endorphins and mood.
– Medications include anti-anxiety drugs and antidepressants targeting brain chemistry.
Conclusion
In summary, chronic chest pain should always be evaluated by a physician to determine the underlying cause and appropriate treatment. Several heart, lung, GI and musculoskeletal conditions can lead to nagging chest discomfort. Diagnostic testing pinpoints the origin, whether it be heart disease, COPD, GERD, costochondritis or anxiety. Specific treatment plans can then be initiated, which may incorporate medications, surgery, lifestyle changes or therapy. Ignoring persistent chest pains places you at risk of missing a serious diagnosis. But seeking proper medical care can identify and resolve the problem, providing symptom relief and optimizing wellbeing.