Chest tightness

Chest pain is discomfort, typically in the front of the chest. It may be described as sharp, dull, pressure, heaviness, or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, or nausea, sweating, or shortness of breath. It can be divided into heart-related and non heart related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or who are old may have less clear symptoms. Chest pain is discomfort, typically in the front of the chest. It may be described as sharp, dull, pressure, heaviness, or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, or nausea, sweating, or shortness of breath. It can be divided into heart-related and non heart related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or who are old may have less clear symptoms. Serious and relatively common causes include acute coronary syndrome such as a heart attack (31%), pulmonary embolism (2%), pneumothorax, pericarditis (4%), aortic dissection (1%), and esophageal rupture. Other common causes include gastroesophageal reflux disease (30%), muscle or skeletal pain (28%), pneumonia (2%), shingles (0.5%), and anxiety disorders. Determining the cause of chest pain is based on a person's medical history, physical exam, and other medical tests. About 3% of heart attacks, however are initially missed. Management of chest pain is based on the underlying cause. Initial treatment often includes aspirin and nitroglycerin. How someone responded to treatment does not necessarily reflect the underlying cause. When the cause is unclear people may be referred for further evaluation. Chest pain represents about 5% of presenting problems to the emergency room. In the United States, about 8 million people go to the emergency department with chest pain a year. Of these about 60% are either admitted to the hospital or an observation unit. This care results in costs of more than 8 billion dollars a year. Chest pain account for about 0.5% of visits by children to the emergency department. Chest pain may present in different ways depending upon the underlying diagnosis. Chest pain may also vary from person to person based upon age, sex, weight, and other differences. Chest pain may present as a stabbing, burning, aching, sharp, or pressure-like sensation in the chest. Chest pain may also radiate, or move, to several other areas of the body. This may include the neck, left or right arms, cervical spine, back, and upper abdomen. Other associated symptoms with chest pain can include nausea, vomiting, dizziness, shortness of breath, anxiety, and sweating. The type, severity, duration, and associated symptoms of chest pain can help guide diagnosis and further treatment. Causes of chest pain range from non-serious to serious to life-threatening. In adults the most common causes of chest pain include: gastrointestinal (42%), coronary artery disease (31%), musculoskeletal (28%), pericarditis (4%) and pulmonary embolism (2%). Other less common causes include: pneumonia, lung cancer, and aortic aneurysms. Psychogenic causes of chest pain can include panic attacks, however, this is a diagnosis of exclusion. In children, the most common causes for chest pain are musculoskeletal (76-89%), exercise-induced asthma (4-12%), gastrointestinal illness (8%), and psychogenic causes (4%). Chest pain in children can also have congenital causes. Knowing a person's risk factors can be extremely useful in ruling in or ruling out serious causes of chest pain. For example, heart attack and thoracic aortic dissection are very rare in healthy individuals under 30 years of age, but significantly more common in individuals with significant risk factors, such as older age, smoking, hypertension, diabetes, history of coronary artery disease or stroke, positive family history (premature atherosclerosis, cholesterol disorders, heart attack at early age), and other risk factors. Chest pain that radiates to one or both shoulders or arms, chest pain that occurs with physical activity, chest pain associated with nausea or vomiting, chest pain accompanied by diaphoresis or sweating, or chest pain described as 'pressure,' has a higher likelihood of being related to acute coronary syndrome, or inadequate supply of blood to the heart muscle, but even without these symptoms chest pain may be a sign of acute coronary syndrome. Other clues in the history can help lower the suspicion for myocardial infarction. These include chest pain described as 'sharp' or 'stabbing', chest pain that is positional or pleuritic in nature, and chest pain that can be reproduced with palpation. However, both atypical and typical symptoms of acute coronary syndrome can occur, and in general a history cannot be enough to rule out the diagnosis of acute coronary syndrome. In some cases, chest pain may not even be a symptom of an acute cardiac event. An estimated 33% of persons with myocardial infarction in the United States do not present with chest pain, and carry a significantly higher mortality as a result of delayed treatment.