HIV complications: Types, symptoms, and staying healthy

Chest Pain: 11 Causes, Symptoms And Treatment Options

Chest pain may indicate a number of health conditions.

Heart Attack

Coronary artery disease (CAD), which occurs when blood flow to the arteries is compromised by a narrowing and hardening of the arteries, can cause a myocardial infarction (heart attack), and chest pain is one of many potential symptoms of this medical event. "Chest discomfort due to CAD is usually diffuse (widespread) and difficult to localize," explains Dr. Jean. "It's also worse with exertion or emotional stress and relieved by rest."

Pericarditis

Pericarditis occurs when the pericardium, a two-layer structure of tissue that surrounds and protects the heart, becomes inflamed due to an infection, a heart attack, certain medications, heart surgery or an injury or medical condition. The pericardium holds the heart in place and helps it function appropriately, and if it becomes inflamed, it may rub against the heart.

Pericarditis commonly causes chest pain similar to that of a heart attack, says Alexandra Kharazi, M.D., a cardiothoracic surgeon at CVTS Medical Group Inc. In San Diego and author of The Heart of Fear, a book about her experiences as a surgeon.

Angina

Angina occurs when the heart isn't getting the blood volume it needs, often resulting in chest discomfort or pain. As well as feeling pain in the chest, some people with angina experience pain in other parts of the body, such as the shoulder, neck, jaw, arms or back, as well as sensations like pressure or squeezing in the chest similar to indigestion. Angina becomes serious when symptoms don't dissipate when a person is resting, an indication that they need urgent care.

Aortic Dissection or Rupture

An aortic dissection occurs when a tear in the wall of the aorta, the heart's main artery, gets bigger. As the tear grows, blood starts to flow between the layers of the wall of the blood vessel. The tear can also inhibit blood flow to important branches of the aorta, potentially leading to additional symptoms like stroke, abdominal pain or leg pain and weakness, according to experts. Chest pain experienced during an aortic dissection or rupture is usually sharp and sudden and may have a stabbing or ripping quality. The discomfort usually occurs below a person's breast bone initially but often moves into the back or shoulder blades.

Heart Valve Disease

Heart valve disease occurs when the valves in the heart stop working properly because they're damaged or because of an underlying health condition. While many people with heart valve disease don't experience symptoms, some may experience chest pain and heart palpitations, as well as fatigue, lightheadedness and shortness of breath.

Pulmonary Embolism

A pulmonary embolism occurs when a blood clot from another part of the body breaks loose and enters the lungs, where it blocks blood flow and inhibits oxygen flow through the body. Chest pain caused by a pulmonary embolism can mimic that of a heart attack, and the condition can be fatal. Certain populations are at a higher risk of developing a pulmonary embolism, including anyone with a prior history of the condition, people who are inactive for long periods of time and those with certain medical conditions, such as heart disease, COVID-19, lupus, interstitial lung disease and some cancers. Smoking, pregnancy, and medications containing estrogen can also increase a person's risk.

Gastroesophageal Reflux

Gastroesophageal reflux, also known as acid reflux or GER, occurs when the contents of a person's stomach rise into their throat, causing heartburn and indigestion that may manifest as chest pain. Acid reflux is usually temporary but may become gastroesophageal reflux disease (GERD), a chronic condition.

Asthma

Asthma is a disease that causes intermittent airway inflammation, potentially leading to chest tightness or pain, breathlessness, wheezing and coughing.

Musculoskeletal Pain or Costochondritis

Sometimes chest pain can stem from the muscles and structures of the chest. For instance, costochondritis occurs when the cartilage between a person's ribs and their sternum becomes inflamed, leading to chest pain. Musculoskeletal chest pain may also stem from the body's muscles or bones, referred pain from other areas of the body or traumatic injuries to the chest, such as broken ribs.

Anxiety or Stress

A number of anxiety and stress conditions can result in chest pain. Generalized anxiety disorder, panic disorder and social anxiety disorder can all cause a feeling of chest pain, often as a result of stress or navigating stressful situations.

Chest Infections

A wide range of infections may cause chest pain, including pneumococcal disease and acute bronchitis. These conditions are usually accompanied by other symptoms, such as coughs, fevers and difficulty breathing. COVID-19 may also lead to chest pain in some cases.

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Urban Living Linked To Increased Risk Of Respiratory Infections In Young Children

Young children growing up in towns and cities suffer from more respiratory infections than those who grow up in the countryside, according to research presented at the European Respiratory Society International Congress in Milan, Italy.

A second study, presented at the Congress and published in Pediatric Pulmonology today (Monday), shows that factors such as attending day care, living in a damp home or near dense traffic increase the risk of chest infections in young children, while breastfeeding reduces the risk.

Researchers say that some children, who are otherwise healthy, can suffer with repeated infections, so it is important to understand why this is and look for ways to help.

The first study was presented by Dr Nicklas Brustad, a researcher and physician on the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) based at Gentofte Hospital and the University of Copenhagen, Denmark. It included 663 children and their mothers who took part in the research from pregnancy until the children were three years old.

Researchers recorded whether the children were growing up in urban or rural areas and how many respiratory infections they developed. This revealed that children living in urban areas had an average of 17 respiratory infections, such as coughs and colds, before the age of three compared to an average of 15 infections in children living in rural areas.

The researchers also carried out detailed blood tests on the mothers during pregnancy and on their new-born babies, and analyzed the children's immune systems when they were four weeks old. They found that children living in urban areas had differences in their immune systems compared to those living in rural areas. There were also differences in the blood samples from the mothers and babies that correlated with the difference in living environment and number of respiratory infections.

Dr Brustad said: "Our findings suggest that urban living is an independent risk factor for developing infections in early life when taking account of several related factors such as exposure to air pollution and starting day care. Interestingly, changes in the blood of pregnant mothers and newborn babies, as well as changes in the new-born immune system, seem to partly explain this relationship.

"Our results suggest that the environment children live in can have an effect on their developing immune system before they are exposed to coughs and colds. We continue to investigate why some otherwise healthy children are more prone to infections than others and what the implications are for later health. We have several other studies planned that will look for risk factors and try to explain the underlying mechanisms using our large amount of data."

The second study was presented by Dr Tom Ruffles from Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK. It included data on 1344 mothers and their children living in Scotland and England. The mothers completed detailed questionnaires when their children were a year old and again when their children where two years old. These included questions on chest infections, symptoms such as coughing and wheezing, respiratory medication, and exposure to potential environmental risk factors.

Analysis of the questionnaires revealed that breastfeeding for longer than six months helped protect babies and children from infections, while attending day care increased the risk. Young children living in homes with visible damp were twice as likely to need treatment with an inhaler to relieve respiratory symptoms and twice as likely to need treatment with a steroid inhaler. Living in an area with dense traffic increased the risk of chest infections, and exposure to tobacco smoke increased the risk of coughing and wheezing.

This research provides some important evidence about how we can help reduce chest infections in babies and toddlers. The benefits of breastfeeding are well-established, and we should continue to support mothers who want to breastfeed their babies. We should also be making every effort to reduce exposure to infections in day care, keep homes free of damp and mold, reduce tobacco smoking and cut air pollution."

Dr Tom Ruffles, Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, Brighton, UK

Co-researcher Professor Somnath Mukhopadhyay, also from Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, added: "The link between damp moldy housing and the need for these very young children to take asthma treatments emphasizes how urgently we need legislation to tackle mold and damp in social housing. For example, here in the UK we want to see rapid implementation of Awaab's Law, which will force social landlords to fix damp and mold within strict time limits." Awaab's Law was proposed following the death of two-year-old Awaab Ishak, caused by the damp and mould in his local-authority home.

Professor Myrofora Goutaki, who is chair of the European Respiratory Society's group on Paediatric respiratory epidemiology and was not involved in the research, says: "We know that some young children suffer with recurrent coughs and colds, and this can lead on to conditions such as asthma as they grow older. It's important that we understand any factors that might be contributing to this, such as the conditions where children live and where they are cared for. The more we understand about these factors, the more we can do to protect the developing lungs of these young children."

Pulmonary Embolism During COVID Infection A Deadly Mix

HONOLULU -- During the first year of the pandemic, patients with pulmonary embolism (PE) had higher in-hospital mortality rates when they also had concomitant COVID-19, according to a nationwide retrospective cohort study.

Using data from the 2020 National Inpatient Sample Database (NIS), 19.8% of patients with both PE and COVID died in the hospital compared with 7.1% of those with PE but without COVID (adjusted OR 3.16, 95% CI 3.07-3.25, P<0.001), reported Rana Prathap Padappayil, MBBS, of Upstate Medical University in Syracuse, New York, during the CHEST annual meeting hosted by the American College of Chest Physicians.

Patients with PE who had COVID were also more likely to require vasopressors (5.31% vs 2.66%; aOR 1.16, 95% CI 1.11-1.22) and extracorporeal membrane oxygenation (0.76% vs 0.30%; aOR 1.62, 95% CI 1.41-1.86), and had longer lengths of stay (7 vs 4 days; P<0.001).

Padappayil noted that acute PE is one of the most common causes of cardiovascular death, with in-hospital mortality rates of around 30%. Studies have shown that COVID is an independent risk factor for developing PE.

Of note, patients with both PE and COVID were less likely to receive certain procedures versus those without COVID, including systemic thrombolysis (2.83% vs 4.71%), catheter-directed thrombolysis (0.13% vs 0.49%), and thrombectomy (0.73% vs 1.94%; all P<0.001).

Because the study data are from 2020 -- the first year of the pandemic -- this may have played a role in the differences among procedure utilization, Padappayil said, noting that a lack of personal protective equipment, a high patient burden, and concerns about evidence likely resulted in patients with both PE and COVID receiving fewer interventions compared with those without COVID.

However, it is unclear if this lack of interventions resulted in higher mortality in patients with PE and COVID, he added.

For this study, the researchers used data from the NIS, which included 425,640 hospitalizations for acute PE (the admitting diagnosis); 11% of these patients also had a COVID-19 infection.

Median patient age was 65, and the majority were women (41.6% with COVID and 50.6% without COVID) and white (53.4% and 70%, respectively); 23% and 19% were African American and 16.4% and 6.7% were Hispanic.

Among the comorbidities present among the patient population were hypertension (62% in both groups), smoking (20% with COVID and 23% without), chronic obstructive pulmonary disease (COPD; 21.6% and 27%, respectively), congestive heart failure (16.5% and 24%), diabetes (13.7% and 10.7%), malignancy (4.1% and 16.6%), and history of venous thromboembolism (4.5% and 9.4%).

Padappayil and team noted that patients with PE and COVID were more likely to be men and non-white, and less likely to have comorbidities, including prior myocardial infarction, diabetes, congestive heart failure, COPD, chronic kidney disease, end-stage renal disease, malignancy, and history of venous thromboembolism.

Limitations to the study included the fact that the NIS database is subject to selection biases and ICD miscoding. In addition, the analysis was limited to in-hospital outcomes, which means the researchers were unable to assess long-term outcomes after discharge.

Padappayil stressed the need for further research using data from the subsequent years of the pandemic. As NIS data become available, his group will look into whether providers have been more willing to use thrombolysis and thrombectomy in patients with both PE and COVID.

Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow

Disclosures

Padappayil reported no disclosures.

Primary Source

CHEST

Source Reference: Padappayil RP, et al "Concomitant COVID-19 infection and pulmonary embolism: incidence and in-hospital outcomes in a nationwide cohort" CHEST 2023.

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