Pain in middle of chest: Causes, Symptoms, Diagnosis, Risk factors, Treatment

Pain in middle of chest can be very annoying and worrisome for any person. So, let us learn all the possible causes, symptoms, diagnosis, and treatment options of pain in middle of chest.

The heart is a crucial organ of our body. It is about the size of one’s clenched fist and rests within the chest cavity. The heart is a muscle which helps in pumping and circulating blood throughout the body. It is divided into two chambers, the upper chamber called ‘atrium’ and the lower chamber, called ‘ventricle’.

These arteries supply blood to the heart, but with the process of ageing, the inner walls of the artery tend to get clogged up with the accumulation of fatty materials. This aggravated condition where there is a complete blockage of an artery leads to a heart attack and leaving an acute pain in middle of chest.

Causes of pain in middle of chest:

There could be multiple reasons for a heart attack. Pain in middle of chest is directly linked to this issue. Some of the main causes of central chest pain are listed below:

Loss of homeostasis in body:

Maintaining homeostasis or balance in the body is absolutely important. Central chest pain is caused by the loss of homeostasis in the body.

Angina:

It is a condition in which there is partial to complete blockage of heart blood vessels that in turn reduces blood flow and oxygen carrying capacity to the heart muscle. It may be triggered by vigorous exercise or emotional distress.

Myocardial infarction:

This condition reduces the blood flow to the heart blood vessels causing the deterioration of heart muscle cells resulting in sudden pain in middle of chest.

Pericarditis:

This lead to inflammation of the structure called pericardium which is present like a sac around the heart resulting in acute pain in middle of chest, shoulder and upper neck.

Hypertrophic cardiomyopathy:

It causes the heart muscle thickening making the heart work harder to pump blood, resulting in eventual chest pain in addition to dizziness, shortness of breath and light-headedness.

Mitral valve prolapse:

This condition makes the heart incapable of closing the valve properly at the right time resulting in palpitations, dizziness and pain in middle of chest.

Coronary artery dissection:

When a tear develops in the coronary artery, it causes a sudden stinging pain inducing a ripping sensation that runs along the neck, bone and chest.

Sources of central chest pain:

• The pericardium i.e. the sac surrounding the heart.
• The lung and the trachea
• Nerves, back including spine area and muscles surrounding it
• Chest wall including ribs
• The aorta and the oesophagus
• The diaphragm that separates the chest and abdominal cavities

Central Chest pain: Risk Factors for pain in middle of chest

There can be varied risk factors when it comes to pain in middle of chest. A few vital risk factors are listed below-

• Digestive: It includes heartburn and oesophagal spasm. Many gastrointestinal disorders also cause acute pain in middle of chest, especially below the breastbone.
• Psychiatric: It includes panic disorder and anxiety attacks.
• Cardiac: Aortic dissection, coronary spasm, angina and heart attack
• Musculoskeletal: Central chest pain can be caused by sore muscles and pinched nerves
• Elevated blood pressure and blood cholesterol levels
• Tobacco use
• Diabetes: Diabetes accentuates the risk of heart diseases like CAD. Coronary artery disease can lead to angina and heart attacks. It happens because it leads to the development of atherosclerosis and elevates the cholesterol levels.
• Lack of exercise and obesity.
• Stress: Excess stress and anger can raise your blood pressure and surges the hormones produced during stress that in turn narrows down your arteries and worsen angina
• A family history of heart disease: If any of your family members like father or mother has a history of cardiovascular disease, it increases the risk of developing heart diseases in you too.
• Pleuritis or pleurisy
• Broken or bruised ribs

Symptoms of Pain in middle of chest:

When encountered by any of the flowing symptoms, be sure to saddle up your horses and begin with the correct diagnosis and treatment procedures. Never delay in such matters as it is highly crucial to get to a nearby hospital in case of recurrent symptoms.

• Dizziness accompanied by trouble in swallowing food and partial loss of appetite.
• Constant pressure and tightness and pain in middle of chest.
• Searing acute pain that radiates all along your back, neck, jaw, shoulders and especially your left arm.
• Shortness of breath causing acute pain in middle of chest.
• Severe pressurised pain sensation when you alter your body position.

Diagnosis of pain in middle of chest:

Chest pain is not always due to heart attack. But, a heart attack is life-threatening, so it is tested in the first instance. Initial diagnosis includes a complete physical examination that includes pulse rate, heart rate, temperature and blood pressure.

To determine the main cause for your chest pain, several tests are carried out like the electrocardiogram (ECG), blood tests, stress tests, chest X-rays, angiogram, CT scan, endoscopy and MRI (Magnetic resonance imaging).

All these tests help to pinpoint the causing factor for pain in middle of chest comparing it with vital symptoms simultaneously. These tests are categorized as immediate tests and follow up tests-

Immediate tests:

• Electrocardiogram (ECG): This test shows if you have developed heart attack now or if you had it in the past. It records the electrical activity of your heart through electrodes.
• Blood tests: These tests are performed to check elevated proteins or enzymes present in heart muscle.
• Chest X-ray: Helps in finding out the condition of your lung, size of the heart, and also the shape of your heart along with important blood vessels.
• Computerized tomography (CT scan)

Follow up tests:

• Echocardiogram: This uses sound waves that are depicted as an image of your heart in the current state.
• Computerized tomography (CT scan): There are various types of CT scans available for checking the heart condition. A CT angiogram is the most appropriate test to detect any blockage in heart and lung arteries.
• Stress tests: These tests give an approximate estimation of exertion of your heart and blood vessels which may clear out that your chest pain is related to heart problem or not. There can be multiple types of stress tests; for example, you might be asked to walk on a treadmill or ride a bike while being attached on an Electrocardiogram (ECG).
• Coronary catheterisation (angiogram): This helps one to identify if any arteries supplying the heart are blocked. It is a simple procedure where a liquid dye is infused into coronary arteries through a thin tube. As the arteries begin to fill up with the injected dye, the blockage becomes visible on the X-ray or a video to detect pain in middle of chest.

Treatment for pain in middle of chest:

After the correct diagnosis, the next step is the treatment. It is highly critical to find the exact cause of pain before treatment can begin. Some of the measures that should be undertaken to treat a sudden pain in middle of chest are:

• Oxygen therapy: This tends to alleviate the stress on the heart and supplement the blood with oxygen.
• Cold compress: Icing the inflamed area reduces pain and swelling.
• Mentholated creams: Mentholated creams like Icy-hot and Ben-Gay may soothe the sore muscles surrounding the chest reducing chest pain to a comfortable level. Although this is a temporary solution to central chest pain, mostly for instant relief.
• Treatment of Angina: Treatment of angina is done to reduce chest pain that occurs due to the diminished blood supply to the heart. The drug Nitroglycerine is the most commonly used treatment. Glyceryl trinitrate or Nitroglycerine helps in the dilation of coronary arteries
• ACE (angiotensin-converting enzyme) inhibitors.
• Use of Beta-blockers to soothe pain in middle of chest.
• Aspirin and other antiplatelets
• Manual chest compressions.

When to see a doctor for pain in the middle of chest:

There may be classic presentations of signs and symptoms for many diseases, but they may also significantly overlap among the symptoms of each condition. Factors like gender, race and age can also affect the overall symptoms. Healthcare professionalists must consider multiple variables before reaching a diagnosis of chest pain.

There are many potential reasons for having pain in middle of chest. When in doubt of even the slightest chest pain, be sure to take action and call a nearby doctor especially if the pain comes suddenly and is not relieved by anti-inflammatory or other self-help care precautions. Consult your physician if you develop any of these symptoms-

• Nausea, dizziness and rapid breathing
• Sudden sharp chest pain especially after long hours of inactivity
• Very low blood pressure and low heart rate
• Severe intermittent chest pain
• Stinging pain in arms, jaw, back, left shoulder and pain in middle of chest.

Acute chest pain is a major symptom that brings patients to the emergency room. Severe pain in the middle of the chest is a major diagnostic challenge for the physician. Electrocardiogram (ECG) is a vital diagnostic aid for patients with chest pain.

References:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660855/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987928/