Chest pain – not always a heart attack

November 12, 2012

Chest pain – not always a heart attack

Chest pain is something generally associated with heart attacks, however, it may have many causes – even persistent coughing can cause pain in the chest area. Since pain in the chest can be the result of persistent or heavy coughing but may also have no apparent cause it is important that investigation is carried out both into the chest pain and the coughing in order to establish whether or not there is a link. Coughing is not necessarily the result of respiratory infection – some gastrointestinal conditions as well as heart disease can also bring on bouts of coughing.

Coughing and pain in the chest

Many respiratory disease cause excessive coughing which may result in pain and discomfort in the chest and whilst breathing. During respiratory infections the airways become inflamed and excessive amounts of mucus are produced – which the body tries to expel by coughing. Whilst respiratory infection is the most common cause of excessive coughing accompanied by chest pain there are also other conditions which may be at the root of the problem.

  • Colds, ‘flu – seasonal as well as swine ‘flu, avian ‘flu and SARS

  • Acute bronchitis, pneumonia and croup

  • Tuberculosis – a disease which is on the increase

  • HIV/AIDS patients who are more vulnerable to infection may develop painful coughs which in turn cause chest pain

  • Sarcoidosis

  • Asthma

  • Post nasal drip – often the result of allergies and persistent sinus problems.

  • Smoking and smoke inhalation

  • Accidental inhalation of foreign bodies

  • Pleurisy – known to cause chest pain and coughing when breathing deeply

  • Tumors

Cardiovascular causes of chest pain include

  • Coronary heart disease, heart failure

  • Pulmonary embolism

Coughing with accompanying chest pain is a known side effect of a number of medications -

  • Blood pressure medication – particularly ACE inhibitors

  • Some statins used to lower levels of cholesterol in the blood

  • Some over the counter cold and ‘flu remedies

  • Some drugs used for weight loss

  • Some individuals experience coughing along with pain in the chest area as a result of gastrointestinal disorders or procedures

  • Gastro esophageal reflux

  • Esophagitis

  • Post endoscopy or barium esophagogram

Medical emergency

On occasion pain in the chest should be regarded as a medical emergency, certain symptoms should be regarded as ‘red flag’ symptoms requiring immediate medical attention -

  • Any loss of consciousness

  • Abnormality of any of the vital signs – pulse, respiratory rate, blood pressure

  • Breathlessness

  • Any signs of shock

  • Irregular heart beat – palpitations or murmur.

Features of chest pain

When discussing pain in your chest with your medical practitioner it is important to provide as much information as possible in order that they are able to make an informed diagnosis -

  • Location of the pain, not just the main site in the chest, but, pain elsewhere should be also mentioned.

  • Duration and preceding events

  • Nature of the pain- is it constant, intermittent, radiating, etc. Does the pain occur as the result of any specific activity?

  • Type and quality of the pain – is it sharp, aching, burning, stabbing – doctors will ask you to explain the pain in your own words, they will also ask about the severity of the pain – generally by asking you to grade the pain from one being the mildest to ten being the most severe.

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