Causes of Chest Pain

Cause of pain:

Angina is caused by ischemia (oxygen starvation) of the cardiac muscle. Coronary artery disease produces ischemia by narrowing the coronary arteries. Subsequently, when the heart tries to perform at a high level (such as during exercise), the narrowed artery is incapable of delivering the necessary blood volume to the working muscle. Ischemia ensues, and the resultant pain is called angina.

Characteristics of pain:

Angina can be quite variable, but classically is described as a pressure-like, squeezing, crushing, or tight pain. Some patients with angina deny pain at all, but agree when the term "discomfort" is described to them. The discomfort often radiates to the jaw, shoulders or arms. It can be accompanied by nausea, sweating, shortness of breath, dizziness, weakness, or fatigue. Classically, angina is often provoked in a predictable manner by exercise, anger, or a large meal. But it can also occur unpredictably, without any obvious triggering factor, and at rest. Angina that is increasing in frequency or that occurs at rest is referred to as "unstable." Unstable angina often precedes a heart attack, and should be treated as a medical emergency.

Evaluation:

The evaluation of angina includes a careful medical history and physical examination, which often point to the diagnosis. Testing always includes an ECG, and often a stress test or a cardiac catheterization.

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