Ask The Doctor

Chest Pain Is Not Always a Heart Attack

Dear Dr. Garner,
I am 43 years old and have a problem that is beginning to worry me. When I sleep, I am awakened with severe pains under my right breast.

I have to turn around in different directions, sometimes I have to get up altogether. Also, I notice that when I press on the spot, it hurts. I can even make the pain worse by pressing hard.
I don’t have any heart problems that I know of, but I never know if I am missing something serious.
How do I know if the pain is something I should be concerned about?

Pain in the Chest From Canarsie


Dear Pain,
In general, a person can never be too smart as to which pain is serious and which is most likely not related to the heart.
Luckily, most of the time it is more annoying than harmful.
There are some symptoms which can help differentiate heart pain from other less serious pain. For instance:
1. A person tends to know his or her body better than anyone. If pains recur enough, you begin to recognize it. The pain may not be related to the heart, but related to the stomach, muscles, or joints.
2. Usually with heart pain there is a feeling that an elephant is sitting on your chest. In addition, the pain may spread to the back, neck, jaw, and arms, most notably the left arm. There may be accompanying shortness of breath, sweating, dizziness or nausea.
3. Chest pain accompanied by a sour taste in the mouth with trouble swallowing; pain that you can point to with one finger; and pain that gets better or worse upon changing your body position, is less likely to be heart related.
4. Pain due to digestion problems include heartburn, swallowing, and feeling of a lump in the throat.
5. Pain that occurs on the right side of the chest pain may be related to the gallbladder.
6. Chest pain that feels like a knife in your chest may be related to the pancreas.
7. Pain may be caused by muscle, bone, or joint problems. An example is a condition known as costochondritis (kos-toe-khon-drie-tis), which is related to inflamed joints in the chest, where the ribs attach to the breast bone. Sore muscles or an injured rib can be very painful.
8. Other chest pain may be related to the lungs, such as: blood clots, fluid build-up, pneumonia, or a collapsed lung.
9. Conditions of the mind can mimic chest pain, including panic attacks, which may resemble signs of a heart attack.
10. Infections, such as shingles, which is related to chickenpox, can cause severe pains. Luckily, there is a vaccination available about which people over 50 should ask their doctor.
Your doctor will initially perform some tests, such as an EKG, blood tests and chest X-ray to help determine the cause of the chest pain.
Other tests, such as an echocardiogram, MRI, and stress test, may be helpful as well.
I believe your pain is related to costochondritis, or inflamed joints where the ribs attach to the breast bone. The pain usually occurs when taking a deep breath, or with coughing. It is also most severe when the person assumes certain positions.
It is often mistaken for a heart attack. The pain of a heart attack is more widespread while costochondritis pain can be identified as a specific spot on the chest, which can be worsened by pushing the finger into the area where the pain is located. Pain associated with the condition is very sharp.
It usually subsides on its own, or with the help of anti-inflammatory medication, or injection of medicine into the joint causing the pain. The bottom line is that chest pain may be a very serious symptom. Not all chest pain is a heart attack but it is best to err on the side of caution.
If you experience any chest pain that feels like there is a weight on your chest that also causes shortness of breath, nausea, or radiation down the left arm, then you should seek immediate medical attention.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.
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