Chest Pain: When Is It Dangerous and What Causes Lie Behind the Symptom?

Chest pain is one of the most common symptoms for which patients seek medical care. It can range from relatively harmless to indicating serious, life-threatening conditions. Due to the potential danger, it is important to understand when chest pain requires immediate attention and when you can see a doctor on a scheduled basis.

When Does Chest Pain Require Immediate Help?

Any sudden, severe, or squeezing chest pain, especially when accompanied by other symptoms such as shortness of breath, cold sweat, nausea, dizziness, or radiation of pain to the left arm, neck, jaw, or back, is a reason to call an ambulance immediately. These signs may indicate acute myocardial infarction—a condition in which part of the heart muscle dies due to a lack of blood supply.

• Acute Myocardial Infarction (AMI): This is the most dangerous cause of chest pain. A complication of AMI can be cardiogenic shock, a life-threatening condition in which the heart cannot pump enough blood to meet the body's needs. The mortality rate from cardiogenic shock associated with AMI remains high, especially in patients over 75 years of age [2].
• Special Risk Groups:
  • Pregnant women: Myocardial infarction during pregnancy is rare, but its frequency is increasing. Diagnosis is complicated because many normal pregnancy symptoms (fatigue, shortness of breath, swelling) can mask heart problems. A multidisciplinary approach to diagnosis and treatment is required [6].
  • Children: Myocardial infarction in children is an extremely rare occurrence. However, it can develop against the background of serious systemic diseases, such as systemic lupus erythematosus, especially in combination with autoimmune hemolytic anemia and antiphospholipid syndrome [1].
• Diagnostic Challenges: In patients with a pacemaker, especially with left bundle branch pacing (LBBP), the diagnosis of AMI can be difficult, as typical ST-segment changes on the ECG may be absent. In such cases, a dynamic decrease in the QRS complex amplitude can be an important sign of myocardial ischemia [7].

Cardiac Causes of Chest Pain: From Infarction to Rare Cases

In addition to acute myocardial infarction, there are a number of other cardiac causes of chest pain:

• Coronary Artery Disease (CAD): A chronic condition in which narrowing of the coronary arteries leads to chest pain (angina pectoris) during physical exertion or stress.
• Link to Oncology: Studies show that women with active or history of breast cancer have an increased risk of hospitalization related to coronary artery disease. This is explained by shared risk factors and the potential cardiotoxic effect of anti-cancer therapy [3].
• Unusual Causes of AMI: In rare cases, myocardial infarction can be caused by external factors, such as a sting from the scorpion species Androctonus crassicauda. In one reported case, a 20-year-old healthy man suffered an AMI after a scorpion sting, emphasizing the need to consider such rare causes in endemic regions [4].

Non-Cardiac Causes of Chest Pain: Not Just the Heart

A significant proportion of chest pain cases are not heart-related. These conditions may be less dangerous, but still require attention and diagnosis:

• Gastrointestinal Causes:
  • Gastroesophageal Reflux Disease (GERD): Heartburn and retrosternal pain caused by the reflux of stomach contents into the esophagus.
  • Esophageal Spasm: Sharp pains mimicking angina pectoris.
  • Complications of Bariatric Procedures: The placement of an intragastric balloon for obesity treatment, although minimally invasive, can lead to serious complications such as gastric outlet obstruction. In one case in a 35-year-old woman, this complication was accompanied by severe nausea, vomiting, electrolyte imbalance, and chest pain, requiring intensive care admission [5].
• Neurological Causes: Chest pain can be a symptom of various neurological conditions that often remain undiagnosed for a long time. These include [8]:
  • Migraine
  • Epilepsy
  • Multiple sclerosis
  • Intercostal neuralgia
• Musculoskeletal Causes: Inflammation of the rib cartilage (Tietze syndrome), chest injuries, muscle strains.
• Psychogenic Causes: Panic attacks, anxiety disorders, and depression can manifest as chest pain.
• Lung Diseases: Pleurisy, pneumonia, and pulmonary embolism (PE) can also cause chest pain.

Diagnosis of Chest Pain: The Path to an Accurate Diagnosis

Because the causes of chest pain are diverse, a comprehensive approach is necessary to make an accurate diagnosis:

1. Anamnesis and Physical Examination: The doctor will clarify the nature of the pain, its duration, accompanying symptoms, risk factors, and medical history.
2. Electrocardiography (ECG): The main method for detecting acute cardiac conditions.
3. Blood Tests: Determination of cardiac biomarker levels (troponin) to diagnose myocardial injury.
4. Imaging Studies:
   • Chest X-ray: To exclude pulmonary pathologies.
   • Echocardiography: Assessment of heart function and its structures.
   • Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): May be ordered for a more detailed evaluation of the lungs, esophagus, or spine.
   • Coronary Angiography: The "gold standard" for diagnosing coronary artery disease, allowing visualization of the coronary arteries [7].
5. Endoscopic Examinations: If gastroenterological causes are suspected (e.g., esophagogastroduodenoscopy).

The Importance of Timely Consultation and Prevention

Chest pain is always a cause for concern. This symptom should never be ignored or self-diagnosed. Timely medical attention is critically important for preventing serious complications and saving lives, especially in heart diseases. Early diagnosis and appropriate treatment significantly improve the prognosis. Prevention of cardiovascular diseases includes controlling risk factors: blood pressure, cholesterol levels, blood sugar, quitting smoking, maintaining a healthy weight, and regular physical activity.

Sources

1. Myocardial infarction in a child with systemic lupus erythematosus. (Myocardial infarction in a child with systemic lupus erythematosus.)
2. Cardiogenic shock as a complication of acute myocardial infarction: a nationwide cohort study. (Cardiogenic shock as a complication of acute myocardial infarction: a nationwide cohort study.)
3. Breast cancer and coronary artery disease: insights from a national inpatient sample analysis. (Breast cancer and coronary artery disease: insights from a national inpatient sample analysis.)
4. Acute Myocardial Infarction Following Androctonus crassicauda Envenomation: A Case Report. (Acute myocardial infarction following Androctonus crassicauda envenomation: a case report.)
5. Emergent Management of Gastric Outlet Obstruction Post-Intragastric Balloon: A Case Report Highlighting the Importance of Preoperative Assessments and Postoperative Monitoring in Obesity Management. (Emergent management of gastric outlet obstruction post-intragastric balloon: a case report highlighting the importance of preoperative assessments and postoperative monitoring in obesity management.)
6. Acute Myocardial Infarction in Pregnancy: A Multidisciplinary Approach. (Acute myocardial infarction in pregnancy: a multidisciplinary approach.)
7. Myocardial Infarction in a Patient With Left Bundle Branch Pacing. (Myocardial infarction in a patient with left bundle branch pacing.)
8. Neurological Causes of Chest Pain. (Neurological causes of chest pain.)

The information presented in this article is for informational purposes only and cannot replace professional medical advice. If you experience chest pain, seek medical attention immediately.