Chest pain in adults is more often the gut than the heart
Chest pain sends about 8 million Americans to emergency departments every year, costing more than $8 billion. Heart disease is behind roughly 31% of adult cases, but digestive problems account for even more, around 42%, and muscle or bone pain for 28%. Telling them apart is hard, and about 3% of heart attacks are initially missed.
Doctors split chest pain into heart-related and non-heart-related causes. Patients describe it as sharp, dull, burning, stabbing, heavy or squeezing, and it can spread to the neck, arms, back, jaw or upper abdomen, sometimes alongside nausea, sweating or breathlessness. Older people and those with diabetes may have less obvious symptoms. Pain caused by too little blood reaching the heart muscle has its own name: angina pectoris.
Different conditions leave different fingerprints. A heart attack typically feels like pressure with sweating and weakness, and where in the heart the damage sits changes the picture: lateral infarctions tend to bring left arm pain, inferior ones more nausea. Pericarditis pain often worsens lying down and eases when sitting forward. Aortic dissection causes severe pain radiating to the back, and ruptured thoracic aneurysms are fatal in more than 94% of cases. A collapsed lung is commoner in tall, slim male smokers, while reflux pain flares after meals or lying flat and may bring a bitter taste. Oesophageal spasm, unlike heart pain, has nothing to do with exertion.
Children are different. Between 76% and 89% of their chest pain comes from muscles and bones, with exercise-induced asthma and stomach trouble making up much of the rest, and chest pain accounts for only about 0.5% of children's emergency visits.
Because the stakes vary so widely, working out the cause relies on history, examination and tests. Among Americans who arrive at emergency departments with chest pain, about 60% are admitted to hospital or an observation unit. Initial treatment often includes aspirin and nitroglycerin, but whether the pain responds does not usually reveal if it comes from the heart. Anxiety and panic can cause chest pain too, though that is a diagnosis reached only after other causes are ruled out.
Source: Chest pain
