A sharp pain or sensation felt around the chest area may not always indicate a possible heart attack — it could be a sign of pleurisy in the lungs or pleuritis. Pleurisy refers to the inflammation of the pleura (a thin membrane that protects the lungs). A common symptom of this problem is chest pain due to pleurisy, one of the lung conditions mimicking a symptom of a heart problem.
Experts speak to Happiest Health, highlighting why the condition occurs in some and how it can be treated.
What is chest pain due to pleurisy?
The two layers of membranes that protect the lungs are known as the pleura. “While the outer layer (parietal pleura) lines the interior of the chest wall, the inner layer (visceral pleura) helps to cover and sculpt the lungs. Since the two layers constantly move over one another due to breathing movements, there is a thin film of fluid between these two layers for lubrication,” Dr Ammaiyappan Palaniswamy C, a pulmonologist at Fortis Malar Hospital in Chennai, explains.
Hence, pleuritic chest pain could stem from inflammation in a localised area of the pleural surface, which comprises the parietal and visceral pleura. “The inflammation causes friction in these membranes, resulting in sharp pain. It gets aggravated by breathing movements and worsens further while coughing,” Dr Palaniswamy adds.
Pleural effusion: Why does it occur?
In some cases, pleurisy is caused by certain diseases, which can lead to a condition known as pleural effusion. “The accumulation of fluid in the pleural surface is called plural effusion,” explains Dr Pujan Parikh, consultant, pulmonary medicine department, Sir HN Reliance Foundation Hospital, Mumbai. He explains its predominant causes:
- Tuberculosis
- Pneumonia
- Connective tissue disorder
- Lung cancer
Once a person has one of these illnesses, either of the pleural layers could experience inflammation, causing pleural effusion. “The membrane begins to secrete fluids in excess when the pleura gets disturbed. According to Dr Palaniswamy, the accumulation of fluid in the pleural cavity can eventually cause pleuritic chest pain.
But there are other disorders that also might result in fluid accumulation in the lungs. “Fluid buildup can result from cardiac failure, particularly when the heart is unable to pump all the blood that it receives. This can sometimes be due to renal failure (chronic kidney disease) as well, but it is mostly caused by hemodynamic abnormalities,” he says. “Then, it would not be related to pleural disease or inflammation. Moreover, it would not be accompanied by intense discomfort, Dr Palaniswamy notes.
Differentiating pleuritic chest pain from a heart attack
It is a common misconception to conclude that a sharp pain in the chest means a heart attack. Dr Parikh defies this and explains that the chest pain sensed during a heart attack is different. “The area of the lungs where pleurisy is typically found is where the pain persists. Usually, this pain is more intense when people cough or take heavy breaths, and it often feels sharp,” he says. “If it is cardiac pain, one will feel it more internally in the chest wall. It may also radiate to the hand and all the way up to the jaw. Those having chest pain due to pleurisy do not experience this. There will be a heavy feeling in the breath when someone has cardiac pain,” he stresses.
Dr Palaniswamy points out breathlessness as a symptom of chest pain from pleurisy caused by high fluid accumulation from pleural effusion. While this can also be mistaken as a symptom of a heart attack, it can be temporarily relieved by holding the breath or pressing the painful part of the chest.
Treatment for pleurisy
The first step during the treatment process, according to experts, is to identify why fluid has accumulated in the pleural space. This is conducted through a procedure called pleural fluid aspiration (a tube or a small needle is inserted in the pleural space to remove the fluid from there). “The fluid is then sent for investigation to identify the underlying disease,” says Dr Palaniswamy.
However, if the fluid is in excess, another procedure called thoracostomy is performed. “In this process, a tube is inserted to continually drain the fluid to alleviate symptoms of pleurisy,” says Dr Palaniswamy. “If the symptoms are mild, an X-ray will be taken to find out the underlying causes and painkillers and antibiotics will be prescribed. Usually, the pain subsides in one or two days,” he adds.
Can pleurisy be prevented?
“It is challenging to prevent pleurisy since it is impossible to foresee whether a person with pneumonia is likely to accumulate excess pleural fluid. Similar to those with tuberculosis, it is impossible to determine whether the symptoms will only affect the lungs or whether the pleura will also be impacted,” says Dr Parikh.
Dr Parikh suggests that patients engage in breathing exercises to expand the lung and maintain the lung cavity whenever they have symptoms related to pleural fluid in their lungs.
Takeaways
- Chest pain due to pleurisy is a condition due to friction or inflammation of the membranes protecting the lungs.
- Sometimes pleurisy develops due to pleural effusion, the accumulation of fluid in the lungs.
- Pleuritic chest pain differs from the pain caused by a heart attack as it is sharper in nature.
