Apart from the chest pain caused by coronary complications (angina), chest discomfort could also be triggered by other physiological conditions including pulmonary and gastric ones.
“It is important to pay attention to the location, intensity and timing of the chest pain, as well as any accompanying symptoms,” says Dr Guruprasad, cardiac electrophysiologist, Fortis Hospital, Vadapalani, Chennai.
Angina and its variants are often warning bells to adopt a healthy lifestyle and diet apart from regularising consultations with a cardiologist.
Happiest Health lists the different types of chest pain, their causes and their implications.
Stable angina
Stable angina usually occurs during physical exertion. Walking or climbing stairs can make the heart beat faster and the oxygen requirement of the heart increases, says Dr Nikesh Jain, consultant cardiologist, Jaslok Hospital and Research Centre, Mumbai. Chest pain associated with stable angina is felt in the middle of the chest and could radiate either to the back or the jaw, he adds.
Stable angina often subsides after taking rest. But it is an early warning about choked arteries affecting circulation and the supply of oxygenated blood to the heart.
Unstable angina
Dr Praveen P Sadarmin, consultant, interventional cardiology, Narayana Health City, Bengaluru, says people with unstable angina may feel chest pain even at rest or during activities with minimal exertion. The chest pain is often more severe and lasts longer than stable angina. Blocked arteries and poor blood supply trigger this condition. This should not be taken lightly as it is often an indicator of a heart attack or a serious variation in the heart rate.
Microvascular angina
The small arteries in the heart supply oxygen and nutrients to the heart muscle. “In microvascular angina, these arteries get damaged. This leads to reduced blood flow to the heart muscle and causes chest pain,” says Dr Sadarmin.
Dr Jain says microvascular angina is often misdiagnosed as stable angina, as the symptoms are similar. According to the American Heart Association (AHA), the differentiating factor of this condition is that it may last longer and could be accompanied by shortness of breath.
Vasospastic angina or prinzmetal angina
Vasospastic angina is caused by spasms in the coronary arteries that narrow them and reduce the amount of blood to the heart, says Dr Jain. According to the British Heart Foundation, this angina variant usually occurs at rest, either early in the morning or at night. Prolonged bouts could lead to heart rate variations and even heart attacks in rare instances.
Aortic stenosis
Dr Praveen says that aortic stenosis usually occurs due to valvular complications in the aorta mainly due to narrowing (stenosis) or blockage with cholesterol-laden plaques. It also affects the heart rate, blood supply and also causes chest pain. This could also be found in people with congenital bicuspid aortic valve condition. The aortic valve has three flaps of tissue to regulate blood flow from the heart into the aorta. However, in those with bicuspid aortic valve condition, there will be only two flaps.
Pulmonary embolism
“Pulmonary embolism occurs due to a blood clot in the lungs that blocks blood,” says Dr Sadarmin. This can cause chest pain. Experts say pulmonary embolism is a very serious condition as the clot forms in the artery that carries blood from the heart to the lungs (pulmonary artery) and this could cause a heart attack.
Aortic dissection
Dr Guruprasad says that chest pain is a common symptom of aortic dissection which occurs due to aortic damage. According to the American Heart Association, this requires immediate medical attention. This occurs when the artery walls carrying blood to the aorta split due to high pressure; It leads to a build-up and subsequent leakage of blood from the damaged arterial wall.
Chest pain due to heart inflammation
There are three kinds of cardiac inflammations – pericarditis, endocarditis and myocarditis. All of them trigger chest pain.
Pericarditis is caused by the inflammation of the pericardium (the fibrous sac-like membrane that covers the heart). Dr Jain adds that viral infections are among the reasons for this condition. Myocarditis is the inflammation of the thickest heart muscle or myocardium and it is often triggered as a reaction to severe viral infections like influenza. Endocarditis is the inflammation of the inner lining of the heart valves and chambers due to bacterial infection.
Heart attack
Dr Jain points out that when a person has constant pain for more than 15 to 20 minutes at rest, this is more likely to be a myocardial infarction or heart attack. Chest pain associated with a heart attack is usually an intense pressure in the chest that radiates to the arms, neck, jaw or back. Immediate medical intervention and emergency support are crucial for the patient’s health and survival.
Heartburn
Heartburn is one of the most common symptoms of bile reflux, acidity and similar gastric issues. This will often give the impression of a heart complication but will soon subside either on its own or with the help of antacids. Bile reflux might need specific treatment at times.
Takeaways
Not all chest pains are due to cardiac complications. They can be because of both cardiac and non-cardiac complications. However, chest pain should not be taken lightly and immediate medical assistance should be sought, especially in the case of recurring and prolonged ones.
