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Chest pain

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From MayoClinic.com


Cardiac causes

If it appears that heart problems are the cause of your chest pain, your doctor may give you medications such as:

  • Aspirin. Aspirin inhibits blood clotting, helping to maintain blood flow through narrowed heart arteries. When taken during a heart attack, aspirin can significantly decrease death rates. You may be asked to chew the aspirin to hasten its absorption.
  • Nitroglycerin. This medication for treating angina temporarily opens narrowed blood vessels, improving blood flow to and from your heart.
  • Beta blockers. These drugs help relax your heart muscle, slow your heart rate and decrease your blood pressure.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart attack.
  • Calcium channel blockers. When treating coronary artery spasm, doctors use heart medications such as calcium channel blockers to relax the coronary arteries and prevent the spasm.

If it's clear you're having a heart attack, you may be treated with clot-busting drugs or undergo a surgical procedure such as:

  • Angioplasty. In this procedure, doctors insert a catheter with a special balloon tip into a blocked coronary artery. The balloon is inflated to open up the artery and improve blood flow to your heart.
  • Stenting. A stent is like a scaffold inside the artery to prop it open after it has been opened with angioplasty.
  • Coronary bypass surgery. This procedure creates an alternative route for blood to go around a blocked coronary artery.

If it's clear you're experiencing a pulmonary embolism, you will likely be treated with emergency blood-thinning medications. Aortic dissection, also an emergency, may require surgery. Other heart and lung conditions can be treated initially in the emergency room. Cancer involving the chest requires treatment and referral to an oncologist, or doctor who specializes in cancer treatment.

Doctors usually treat angina — chest pain caused by restricted blood flow to the heart — with medication, angioplasty or coronary bypass surgery. For people who don't respond to or who aren't candidates for these standard treatments, doctors at some major medical centers are evaluating an alternative treatment called enhanced external counterpulsation (EECP) for treatment of chronic angina.

Most of the time, chest pain isn't related to emergency heart or lung problems. If doctors determine you're out of immediate danger, evaluation and treatment may shift to an outpatient setting. You may be referred to your own physician or a specialist for further evaluation.

Noncardiac causes

Treatments for noncardiac causes of chest pain depend on the type of problem. These problems and their treatments include:

  • Heartburn. If your symptoms suggest heartburn, you'll likely need to take an over-the-counter or prescription-strength stomach acid blocker or antacid in the emergency room. Most episodes of heartburn are isolated events caused by overeating. However, if you experience frequent heartburn (at least one episode a week), your doctor or a doctor who specializes in stomach and intestinal problems (gastroenterologist), may ask you to undergo more tests. Left untreated, chronic, frequent heartburn can occasionally lead to scarring and narrowing of your esophagus. Treatment for chronic heartburn may include dietary modifications, antacids, acid blockers or other prescription medications and, in some cases, surgery.
  • Panic attack. This anxiety-related cause of chest pain can be treated with prescription anti-anxiety medications, relaxation techniques and counseling to find out what may be triggering your attacks. Panic attacks are often mistaken for heart attacks, and many people are seen in emergency rooms for this problem. But once your condition is diagnosed, you can be referred for treatment to help you gain control over these attacks.
  • Pleurisy. This inflammation of the pleura, the membrane that lines your chest cavity and covers your lungs, may result from a variety of conditions, including pneumonia and, rarely, autoimmune conditions such as lupus. Your doctor will want to identify and treat the underlying disease that caused pleurisy. Over-the-counter pain relievers can help minimize the pain until the inflammation subsides.
  • Costochondritis. Treatment for this inflammation of the cartilage of your rib cage is generally rest, heat and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others).
  • Sore muscles, injured ribs or pinched nerves. Chest pain from injured ribs, pinched nerves and sore chest muscles improves with time and self-care measures recommended by your doctor.
  • Swallowing disorders. These disorders have many causes, which can usually be treated with medications, minor surgery or endoscopic techniques. You'll probably be referred to a gastroenterologist for evaluation and treatment.
  • Shingles. Treatment with acyclovir (Zovirax) or a similar antiviral medication is best started as quickly as possible, preferably within 24 hours from the onset of pain or burning, and before the appearance of blisters. Doctors use other treatments, such as analgesics and antihistamines, to control symptoms such as pain and itching.
  • Gallbladder or pancreas problems. You may need surgery to treat an inflamed gallbladder or pancreas that's causing pain to radiate from your abdomen into your chest.

Chest pain can be one of the most difficult symptoms to interpret. But spending a few hours in the ER having your chest pain evaluated can bring you peace of mind. You may feel the most relief by simply finding out the cause of your pain.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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Last Modified : 03/15/08 01:41 AM