Causes

Most people who get chest pain immediately wonder if they're having a heart attack-what doctors call a myocardial infarction. And maybe they are. But it's just as likely that that chest pain is caused by the raspberry Slurpee you just drank. Or the follow-through on your golf stroke. Or even the chewing gum you were just popping.

The problem is that there are so many different kinds of chest pain and so many different causes that it takes a doctor to tell you what the pain means. And sometimes even your doctor's going to have trouble.

Chest pain is that complex.

Pain that's related to the heart, for example, is frequently described as sustained, viselike and agonizing. It's usually-but by no means always- located in the upper third of your breastbone. It almost always gets worse when you exert yourself. doctors explain, and most often radiates out from the heart. It usually does not get worse when you move your shoulder, is usually not altered by breathing and is rarely relieved by vomiting, belching or passing gas.

Besides heart attack, heart problems that can cause chest pain include leaky or narrowed heart valves or valves that have slowly stiffened: weakened arteries that balloon out and slow or even stop the flow of blood: inflammation, infection or even swelling of the heart muscle or the membranous bag in which it sits; and angina, a common chest pain that is triggered by too little oxygen reaching the heart.

Typically, doctors say, angina pain is described as a pressing or squeezing sensation that begins in the center of your chest and spreads to your shoulders or arms - frequently along the left side - or even to your back, neck or jaw. Less commonly, the pain may occur only in your arms, wrists or neck. It usually lasts only a few minutes and is most often triggered by exercise, emotional upset, exposure to the cold or any other situation that increases your heart's workload and subsequent demand for more oxygen. And, although angina is occasionally caused by a coronary artery spasm, it usually happens because the coronary artery is blocked with so much "sludge" that the flow of blood-and its precious oxygen cargo-is reduced to less than 40 percent of normal. In either case, however, blood flow and oxygen availability are usually restored within 5 to 15 minutes, and the pain disappears.

The pain of a heart attack is almost always more severe than that of angina, doctors say, and it usually lasts longer-sometimes for hours. The pain can vary in intensity from mild discomfort to excruciating pain. and it is frequently accompanied by sweating. nausea, vomiting, dizziness or fainting, even a feeling of impending doom. Keep in mind, however, that at least 10 percent of those who are having a heart attack never feel a thing. A heart attack doesn't have to hurt.

Chest pain that's not related to your heart, doctors say, may feel as though someone stabbed or poked you with a finger. It may be dull. and it's often at the lower end or below your breastbone, even under your nipple. It's unlikely to get worse with exertion-sometimes it can even be relieved by physical activity-although in many disorders the pain will get worse when you move your shoulder. If you have pain in your chest and you can reproduce the pain or make it worse by touching the sore spot, chances are it is not due to your heart. Some kinds of chest pain that are not related to the heart may be made worse with breathing and better with belching, vomiting or passing gas.

Chest pain that's not caused by your heart, doctors say. can come from the lungs, esophagus or even your abdomen. It can be caused by a virus, fungus disease or mold. It also can be caused by drinking cold liquids, indigestion or swallowing air while eating, talking or chewing gum. It can be caused, especially in teenagers, by minor malfunctions - perhaps by inflammation from a stretched ligament-in the bones and cartilage of the chest wall, brought on simply by bending forward, stretching. reaching for an object, turning over in bed or playing tennis or golf. Sometimes it's even caused by the way you sit.

Suggested Treatment

Because pain can mean so many things, diagnosis should be made only by your doctor. If you're bothered by any pain in your chest, contact your doctor immediately.

Accompanying Symptoms

Chest pain accompanied by a cough that frequently produces blood-stained mucus can be a sign of pneumonia, tuberculosis, a blood clot in your lung or lung cancer. Call your doctor.

SYMPTOM: Sores

SYMPTOM: Stretch Marks

SYMPTOM: Sweating

SYMPTOM: Thickening

SYMPTOM: Warts

SYMPTOM: White Patches

SYMPTOM: Wrinkles

Symptom 1      Symptom 4

Symptom 2      Symptom 5

Symptom 3      Symptom 6