How much do you know about the truth behind the disease hidden behind chest pain?

Author: Jiang Guanchao, Chief Physician, Peking University People's Hospital

Reviewer: Zhi Xiuyi, Chief Physician, Xuanwu Hospital, Capital Medical University

Chest pain is a common clinical complaint, and its causes are complex and diverse, involving multiple parts such as the chest wall, pleura, lungs, esophagus, mediastinum, heart, and large blood vessels. Chest pain caused by different causes varies in symptoms, pain properties, and accompanying symptoms. Therefore, for patients with chest pain, it is crucial to identify and accurately determine the cause in a timely manner.

Trauma is a direct and important factor causing chest pain. Minor trauma, such as skin abrasions, may only cause pain when touched, but will not increase with deeper breathing. However, when the trauma affects muscles, periosteum, and soft tissues, chest wall activities such as deep breathing or coughing may aggravate the pain. If the ribs are injured and rib fractures occur, the chest pain symptoms will become particularly severe, and even slight breathing or coughing movements may cause unbearable pain. At this time, the chest compression sign becomes a key sign to distinguish between rib fractures and soft tissue contusions. If the doctor suspects a fracture, an X-ray examination can confirm the diagnosis.

Figure 1 Original copyright image, no permission to reprint

In addition to chest wall trauma, costochondritis is also a common cause of chronic chest pain, especially in young women. The disease is mainly manifested by soreness or tingling on both sides of the sternum, especially in the second and third costal cartilage areas. This pain sometimes radiates to the shoulders and back, and the pain is significantly aggravated when lifting heavy objects or doing chest expansion exercises. Costochondritis belongs to the category of aseptic inflammation. Its onset is closely related to factors such as trauma, fatigue, and mood swings, and it has a certain degree of self-healing. After excluding the possibility of organic lesions such as heart disease and lung tumors, doctors can usually diagnose costochondritis through the patient's symptoms, signs, and X-ray results. In terms of treatment, maintenance is the primary measure. Appropriate physical therapy such as hot compresses can effectively relieve symptoms. For patients with severe symptoms, local closed treatment can be considered.

In addition, pleurisy, as an inflammatory disease in the pleural cavity, can also cause chest pain symptoms. The chest pain caused by pleurisy is mostly due to the friction between the visceral pleura and the parietal pleura, and this pain will become obvious as the respiratory movement intensifies. Early pleurisy may be accompanied by low fever symptoms. As the disease progresses, pleural effusion may occur. Although this will relieve chest pain to a certain extent, it will further aggravate dyspnea. The diagnosis of pleurisy requires comprehensive consideration of the patient's symptoms, signs, and the results of auxiliary examinations such as chest X-rays and pleural effusion tests. In terms of treatment, anti-infection, anti-tuberculosis or anti-tumor treatment is required for the specific cause, and pleural effusion should be extracted as appropriate to relieve the patient's symptoms.

Of course, there are some special types of chest pain, each with its own unique warning significance. For example, pneumothorax is a common cause of chest pain in young people, especially during strenuous exercise. When air bubbles on the surface of the lungs rupture, causing the gas in the lungs to enter the chest cavity and compress the lung tissue, the patient may suddenly experience severe chest pain accompanied by difficulty breathing. During auscultation, it can be found that the breath sounds on the affected side are weakened or disappeared, and X-ray examination can confirm the diagnosis. Pneumothorax needs to be treated promptly to restore the normal function of the lung tissue and avoid the occurrence of complications.

On the other hand, patients who have been bedridden for a long time or have just undergone surgery should be highly alert to the possibility of pulmonary embolism if they suddenly experience chest pain accompanied by dyspnea. Pulmonary embolism is caused by the detachment of blood clots in the veins of the lower extremities and the obstruction of the pulmonary artery. Its symptoms include chest pain, dyspnea, and decreased blood oxygen saturation. The disease has an acute onset and is dangerous, requiring immediate treatment. The key to preventing postoperative pulmonary embolism is to encourage patients to get out of bed and move around early, and to use anticoagulants and elastic stockings when necessary.

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Finally, advanced lung cancer is also a disease that causes chest pain. When the tumor invades the chest wall, intercostal nerves, or bone metastasis occurs, the patient may feel persistent chest pain. Common symptoms of lung cancer also include irritating cough, sputum, and hemoptysis. For people with high risk factors for lung cancer, chest CT screening and pathological and cytological examinations should be performed as soon as possible to confirm the diagnosis.