When to worry about chest pain? Differences between left- and right-sided chest pain

Chest discomfort is often a cause for alarm because people generally associate it with heart attacks or other cardiac conditions. However, discomfort in the chest can occur from a number of different causes, some of which are relatively benign.

Pain can occur in varying degrees, such as aching, burning, sharp, dull, stabbing, squeezing or a crushing sensation. These different sensations can often tell medical professionals something about the nature of the problem. Knowing the difference between a serious problem and a minor one can save your life. A closer look at pain that centers in the chest, and the problems that can occur involving the organs in the chest cavity and their function, can help individual know when to seek medical help to avoid a serious consequence.

Chest Anatomy

The chest cavity consists of a cage of bone that is covered with fat, muscle and blood vessels. Inside this cavity lay the internal organs of the chest, the lungs, heart and liver. The muscles that surround the chest provide flexible movement that allows expansion for breathing, twisting, turning and lifting. Nine different muscles in the upper back and chest help to move the humerus bone of the upper arm.

The sides of the chest contain a number of muscles, such as the serratus anterior and the pectoralis minor muscles, that allow a broad range of motion in the thoracic region. These muscles allow individuals to move their arms into different positions. The coracobracialis and pectoralis major muscles allow the arm to move forward and grasp objects. The teres major and latissimus dorsi allow the arm to extend and pull objects downward. The supraspinatus and deltoid muscles allow the individual to extend and swing the arm, as in throwing a ball. Other muscles allow the rotation of the humerus bone in the arm, such as the subscapularis, infraspinatus and teres minor muscles. The rotator cuff muscles are also involved in the movement of extension and swing such as is used in throwing a ball. These complex mechanisms must all coordinate together properly in order to function normally within the human body. The chest of males contains considerably more muscle that provides the shape of the masculine chest. Females have much more fat in their chests, composing the breast tissue that protects the mammary glands needed to nursing offspring.

A number of different muscles of the chest and back are also involved in the mechanism of breathing, allowing appropriate expansion and compression of the lungs. This action is aided by the diaphragm, a thin, dome-shaped muscle that lies at the bottom of the rib cage. Its movement is critical in the ability to draw in air and release carbon dioxide from the body.

The heart is a muscular organ, located to the left of the breastbone and between the two lungs, that functions as the power center of the body’s circulatory system. It is a the pump that helps to move blood and nutrients to all parts of the body, and it removes waste products from the cells so they can be removed by the kidneys and intestines. The heart, an organ that is the size of a fist, expands and contracts 100,000 times each day to pump about 2,000 gallons of blood through the body each day. Essentially, the heart is a hollow organ with four chambers, the right atrium, the right ventricle, the left atrium and the left ventricle. The left and right sides of the heart work together to provide the pumping action needed to circulate blood to all parts of the body.

Right Side Heart Mechanism (right side chest):

· The blood enters the right side of the heart through two large veins called inferior and superior vena cava, bringing oxygen-poor blood into the organ.

· The atrium contracts carrying blood from the right atrium in the right ventricle through a tricuspid valve.

· The tricuspid valve closes, preventing backflow.

· The right ventricle contracts, carrying blood to the lungs where it is oxygenated.

· The blood returns to the heart via the pulmonary veins.

Left Side Heart Mechanism (left side chest):

· Pulmonary veins carry oxygenated blood to the left atrium of the heart.

· The left atrium contracts, sending blood to the left ventricle.

· The mitral valve shuts, preventing backflow.

· The left ventricle contracts, sending blood through the aortic valve and into the body.

The heart is controlled by a complex electrical system that ensures is effective function in a variety of circumstances. A number of problems can develop within this electrical system that can cause chest pain and may require medical treatment. In addition, the circulatory system itself can develop narrowing or blockages in the linings of the vessels that carry blood throughout the body. When these issues occur, individuals may experience pain in the chest, weakness, fainting or other symptoms.

Modern medicine has provided a number of treatments for these conditions that allow individuals freedom from pain and the ability to be active in their everyday lives. However, chest discomfort is not always a simple matter to diagnose. A variety of tests are available to help physicians find the cause of chest discomfort so they can determine the right course of treatment.

Cardiovascular Conditions That Cause Chest Discomfort

Cardiovascular disease can cause pain in the chest when an insufficient amount of oxygen-rich blood is available. This lack of blood flow can cause pressure or a feeling of squeezing in the chest, which can also radiate into other parts of the upper body. This condition, called “angina,” is a symptoms of underlying coronary heart disease. It usually occurs when one or more arteries is narrowed or blocked. Angina can be either stable or unstable and can lead to heart attacks.
You are at higher risk for angina and coronary heart disease if the following conditions are present:

  • High levels of low-density protein (LDL) in the blood
  • Untreated high blood pressure
  • Obesity or significantly overweight
  • Diabetes
  • Smoking
  • Metabolic syndrome, a combination of symptoms that include high waist circumference, high blood pressure, high cholesterol, high triglyceride levels and high fasting blood glucose levels
  • Poor diet
  • Over age 45 for men and over age 55 for women
  • Family history of heart disease

Other Causes of Pain in the Chest

Chest discomfort can also be a result of simple strain of the muscles in the chest. If you have been engaging in a new workout at the gym that involves your upper body, the movements could have left you with significant pain in your chest muscles. Similarly, chest pain often occurs after people have been engaged in home improvement projects that involve heavy lifting or suspending materials at a specific level for a period of time. They may have chest discomfort and worry that they have strained their hearts. However, pain or strain in the muscles of the chest will respond to over-the-counter pain relievers, such as ibuprofen. Icing the muscles and resting them for a period of time will resolve the discomfort. If this treatment does not help the discomfort in the chest, or if you have any concerns about pain, seek medical attention to make sure you do not have a cardiovascular problem.

Sometimes, sudden chest discomfort occurs when the individual changes position. The pain may be sharp or radiating when leaning over or getting up from a lying position. This problem is usually the result of lung problems, such as asthma or pneumonia, which causes fluid buildup or inflammation of the membranes. Appropriate treatment of the underlying lung condition will help to relieve the chest discomfort. Your physician can provide appropriate medication to relieve this type of pain.

Another common problem that causes discomfort in the chest is heartburn or gastroesophageal reflux disease (GERD). The pain from these conditions can be centered in the chest, or it can radiate to the neck and throat. If you have had severe heartburn before or have been diagnosed with GERD, you will recognize the symptoms and take appropriate remedies. Peptic ulcers can also cause pain in the chest, particularly if the individual smokes, drinks alcohol or takes NSAIDs pain relievers for other conditions. However, if the nature of the pain is unusual, you should see a doctor to ensure that it isn’t a more serious condition. Physicians can provide appropriate antacid medications to relieve pain from heartburn or GERD.

Gall bladder problems can also cause pain in the chest that can feel similar to a heart attack or other heart condition. Ultrasound, CT scan or MRI tests can indicate whether the problem is related to gall bladder disease rather than the heart.

A panic attack can also cause pain in the chest so severe that individuals often believe they are having a heart attack. However, this type of pain does not originate within the heart itself. Rather, it is caused by a severe anxiety reaction that produces extreme tension that causes rapid heartbeat, chest discomfort and difficulty breathing. Tests will indicate no irregularities in the heart. Panic attacks are generally treated with anxiety medications, antidepressants or psychiatric counseling to deal with the underlying anxiety disorder (try L-Theanine against anxiety).

When To Worry About Chest Discomfort

Severe pain that centers in the chest can be one of the symptoms of a heart attack, but many people experience a heart attack in different ways. In general, any pain in the chest that last for more than a few minutes and is unrelenting, that is, its severity continues despite changes in position or other common attempts to relieve it. Chest discomfort that is associated with a potential heart attack may or may not be present in an individual.
However, other symptoms may also occur with a heart attack:

  • Pain in the left arm – Individuals may experience the pain in their left arms.
  • Pain that radiates into the shoulder or the jaw – Lingering pain that radiates into the shoulder or up into the neck or jaw can signal a heart attack.
  • Nausea and vomiting – A heart attack may begin with feelings of nausea or vomiting. This symptom may come on suddenly and is unrelated to what the person has eaten.
  • Lightheadedness – The individual may feel dizzy or lightheaded.
  • Shortness of breath – Chest discomfort may be accompanied by difficulty breathing or a feeling of tightness in the chest that makes it hard to breathe.
  • A cold sweat – Individuals may break into a cold sweat, all over their bodies.
  • Severe fatigue – Women can experience a heart attack differently, sometimes experiencing severe fatigue instead of classic chest symptoms.
  • Abdominal pain – Women may experience abdominal discomfort, rather than the classic chest symptoms.
  • Pain in the back – Women may also experience pain in the upper back rather than in the chest.

Other Types of Coronary Disease

Angina can also be caused by a number of other coronary conditions that prevent proper function of the heart, the arteries or values within the organ:

  • Stable angina
  • Unstable angina
  • Variant (Prinzmetal) angina
  • Microvascular angina
  • Pulmonary embolism
  • Aortic dissection
  • Aortic stenosis
  • Hypertrophic cardiomyopathy
  • Pericarditis

Diagnosing Chest Discomfort

When you come to the emergency room or your doctor’s office with chest pain, the physician will ask a number of questions and administer several tests to determine the source of the problem. He or she will probably ask such questions as:

  • Where is the pain located?
  • Can you rate the severity of the pain (on a scale of 1 to 10)?
  • How long have you experienced the pain?
  • Have you ever experienced similar pain before?
  • Have you recently had a serious respiratory problem or do you have lung disease?
  • Have you ever been diagnosed with cardiovascular disease?

Testing for Chest Discomfort

If the physician suspects a heart problem may be the source of the pain, he or she can order a number of tests that provide more information about what is going on in the body:

  • Blood tests – Certain enzymes in the blood can indicate damage to heart cells.
  • Electrocardiogram – This device attaches electrodes to the skin of the chest to record electrical activity in the heart. The ECG can determine if a heart attack is occurring or has occurred recently.
  • Chest x-ray – A chest ray can show the size and shape of the heart and blood vessels to determine changes.
  • Computerized tomography (CT scan) – This test can determine if there are problems in the heart’s aorta or if a blood clot is present in the lungs. Other types of CT scans can indicate the presence of calcium in blood vessels that are causing blockages.
  • Echocardiogram – This device uses sound waves to create an image of how the heart is functioning.
  • Stress tests – Stress tests provide a way to measure heart activity during exertion so determine how well it functions.
  • Angiogram (coronary catheterization) – This test,in which a dye is injected into the arteries, helps to diagnose arteries that are narrowed or blocked, which can affect heart function.

Treating Heart-Related Pain in the Chest

Once the cause of the discomfort is pinpointed, the physician can provide an appropriate remedy. If the cause of the pain is muscle pain or a lung problem, these can be treated with pain relievers or vasodilator medications. If tests indicate the problem is heart-related, a number of treatment options are available:

Medications

Heart conditions are often controlled with medications that help to increase blood flow to the heart and improve the heart’s function:

  • Aspirin – The doctor may provide aspirin to improve blood flow to the heart.
  • Clot-busting drugs – These medications can dissolve a blood clot that may be blocking the blood from reaching your heart.
  • Artery relaxers – Drugs such as nitroglycerin can help to relax arteries so that blood can flow to the heart more easily. Some blood pressure medications can also be used to relax arteries.
  • Blood thinners – Medications that inhibit clotting can help blood flow more freely to the heart muscle.

Surgical Remedies

A number of surgical techniques have been developed to improve blood flow to the heart, which in one of the major causes of heart pain:

  • Balloon insertion – Special balloon-like devices can be inserted to unblock arteries and improve blood flow to the heart.
  • Stents – Stents are wire mesh tubes that are inserted in a folded position and then expanded to hold open a narrowed artery, thereby increasing blood flow to the heart.
  • Bypass surgery – In this technique, an artery from another part of the body is re-located to create an alternate route for blood flow.
  • Dissection repair – If the aorta has ruptured, a repair of the artery can be done to restore blood flow to the heart.

Chest discomfort can signal a serious condition that needs immediate medical help. If you are unsure about the source of your pain, don’t hesitate to go to the emergency room where you can get a proper diagnosis of your problem. This is one situation where it is much better to be safe than sorry. Chest discomfort related to a heart conditions can be resolved or improved with appropriate treatment.

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Patricia K.

She is our health expert (medical student), with a little bit of over-meticulousness and precision. She has an unquenchable desire to help others.