CHEST PAIN

For acute chest pain click here However, chest pain does not always come on acutely but sometimes develops over a period of time. In the early stages it may not be clear whether there is actually something wrong or whether you're just unfit. If there is any doubt it is worth discussing it with the doctor.

TYPES OF CHEST PAIN

• CHEST PAIN COMING ON WITH EXERTION
  • Angina is the commonest and most important cause of chest pain coming on with exertion and going off within a minute or two of resting. However, it sometimes comes on with emotion or even at rest. It is usually described as a tight pain or crushing pain and is usually in the centre of the chest though it may go up into the neck or jaw even or to the top of the stomach. It often goes down into the left arm which may go numb or tingle - rarely this may be the only pain and there is no chest pain as such. For an individual there tends to be a pattern so that recognition of the symptoms is not a problem. Departure of angina pain from its usual pattern - earlier onset, not responding to rest or treatment as usual, return of pain after a short interval, change in nature of the pain, associated nausea, vomiting, a cold sweat, dizziness, faintness or shortness of breath all signify possibly serious developlopments and urgent medical advice should be sought.
  • Other causes Musculo-skeletal chest pain and pain from irritation of the lining of the lung (pleurisy) are likely to get worse with exercise and muscular pains may come on with lifting. Usually these are sharp pains and are not situated in the centre of the chest (see below). It is sometimes difficult even for doctors to tell the difference between these pains and angina without further tests. If you are in the slightest doubt you should get this checked out at the surgery - especially if you have associated symptoms such as a cough or a fever. Often we are able to reassure you after a simple discussion of your symptoms and an examination
• BURNING CHEST PAIN AND CHEST PAIN ON SWALLOWING These are grouped together because the cause of both is likely to be the reflux of acid stomach contents into the gullet (oesophagus). This may cause inflammation (oesophagitis) and in the most severe cases a narrowing (stricture) of the gullet. In the mildest form there may just be a burning sensation on bending forward, lying flat in bed, after a large meal or straining at stool. If the gullet becomes inflamed then the pain may be present most of the time and made worse on swallowing hot or spicy food. The milder symptoms are very common from time to time but if they are persistent, severe or associated with weight loss then further investigation is required.

• PAIN AROUND THE CHEST It's quite common to get pain in the chest wall itself. There may be pain on breathing and/or coughing. If there is tenderness then the source of the pain is likely to be coming from near the surface in the bones or muscles of the chest wall. If there is no tenderness at the site of the pain it is likely to be coming from the deeper tissues such as the lining of the lung (pleural membrane). Unless the pain is trivial and short-lived it needs to be checked for whilst most cases are caused by relatively minor illness there are serious causes that need to be taken into account. If it is severe with sudden onset it needs checking out urgently.

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