Chest pain is a symptom that can provoke considerable anxiety to both the patient and his or her doctor. Justifiably so, as this can spell the onset of serious heart disease or a heart attack. But chest pain is merely a symptom, the causes of which are many and varied and not always serious or related to the heart. It is the task of your doctor to differentiate between a minor cause of chest pain and that, which may more serious and possibly life threatening.

Heart attack is the number one killer of men over the age of forty worldwide. Many deaths may be prevented if warning symptoms are recognized by the patient and discussed with the doctor.

It is not uncommon for patients, usually males over the age of forty but especially in the fifth and sixth decade of life, to develop coronary artery disease. In this condition the coronary arteries, which supply blood and oxygen to the heart muscle, are narrowed by plaque made up primarily by cholesterol. There may be quite marked narrowing before the person experiences any symptoms. Chest pain in this situation is called angina pectoris (angina) and is produced when the heart muscle is not receiving an adequate supply of blood and oxygen due to the narrowing in the coronary arteries. This typically occurs during exertion (exercise) when the person experiences chest pain that disappears once the exercise stops. Angina is described as an intense heavy or crushing sensation across the chest, which may be felt in the left arm and sometimes in the lower jaw. Very rarely the pain is felt only in the arm or upper abdomen. The pain is usually not felt in a small localized area of the chest and is not usually described as sharp or burning in nature.

The importance of recognizing angina is that it can lead to the more serious condition of a myocardial infarction or heart attack in which an area of heart muscle dies as a result of having its blood supply completely cut off. This occurs when a coronary artery blocks completely so cutting of all blood flow. The pain of a heart attack is very similar to that of angina described above, although it is often more severe and lasts longer-typically more than 15 to 20 minutes. During a heart attack the patient often experiences nausea, sweating and a feeling of intense anxiety. The patient who has suffered angina previously, may not get any relief from their nitrolingual spray or tablets that previously gave them quick relief. It is vital for patients possibly suffering a myocardial infarction to waste no time in seeking medical help and it is advised that patients chew an aspirin tablet if they have not already taken an aspirin that same day. It is now possible to actually limit the extent of heart muscle damage caused by a heart attack by using special drugs (thrombolytics). Here the blood clot causing the blockage is dissolved by drug treatment. For this to be effective this medication must be given promptly, preferably within an hour of the onset of symptoms.

At the other end of the spectrum are more common causes of chest pain unrelated to the heart.

The oesophagus or food pipe sits just behind the heart and can be the source of chest pain either through the back flow of acidic stomach juices into the oesophagus causing burning (reflux) or actual inflammation and ulceration/erosion of the lining of the oesophagus, which is very sensitive to the effects of stomach acid. This produces the typical heartburn type chest pain, which is described as burning in nature and is felt directly behind the breastbone or sternum and often leads to an acidic backwash of juices in the throat (so called acid brash). Heartburn is typically worse at night especially if the evening meal is consumed close to retiring to bed, but can be provoked by bending forward or after meals. Patients often gain relief from assuming an upright position or taking some antacid by mouth. Occasionally the oesophagus can undergo an intense spasm, which can feel very much like a heart attack. It is good advise in this case to assume it is the heart until proved otherwise by your doctor. Heartburn is not an entirely benign condition as in rare cases the oesophagus can become scarred and permanently damaged.

One of the more common sources of chest pain is from the chest wall. This is made up of the rib cage, cartilages and muscles. These can be easily injured and generally recognized as a localized sharp pain brought on or made worse by movement or a full breath. Often the patient can localize the tender area but occasionally the source is the upper back (Thoracic) spine and associated nerve roots. One well recognized syndrome is seen commonly in young women particularly, called costochondritis or Tietze's syndrome. Here there is an inflammation of the junction between a single rib and its adjoining cartilage usually involving the 2nd or 3rd rib just to the left of the breastbone at the upper end. The pain is sharp or dull but quite localized (confined) to a small area in the front of the chest. This is usually a harmless problem and settles with time or with aspirin.

Chest pain can occur in association with an infection of the lungs or lower respiratory tract. In this situation the patient will have a cough, often productive of some phlegm and associated with fevers. Here, sharp chest pain that is typically worse with coughing or on taking a breath, may be caused by pleurisy with an underlying pneumonia and deserves urgent attention from your doctor.

Your GP is the best person to consult in the event of chest pain, as it is not always easy for the patient to differentiate between benign and more serious causes. Get advise early and don't ignore what your body may be telling you.