Regarding chest pain, you need to know these medical knowledge!

Author: Shi Huanzhong, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Wang Qian, Chief Physician, Third Medical Center, PLA General Hospital

Have you ever experienced chest pain?

For ordinary people like us, if we experience chest pain, we usually take it very seriously and go to the hospital for examination in time.

Unlike coughing, fatigue, etc., many people will endure it as long as they can, and will endure it for a month, two months, or even several years before going to the hospital for treatment.

Figure 1 Original copyright image, no permission to reprint

Chest pain is often unbearable, and most people will go to the hospital for treatment in a timely manner.

1. What causes chest pain?

The causes of chest pain can be roughly attributed to several main aspects:

First of all, various diseases of the thorax itself are the primary cause of chest pain, including intercostal neuralgia, thoracic trauma, and metastasis of malignant tumors from other parts of the body to the chest, such as ribs, sternum, spine, etc., all of which may lead to the occurrence of chest pain.

Secondly, heart-related diseases are also causes of chest pain that cannot be ignored. Particularly common are myocardial ischemic diseases, such as coronary artery atherosclerosis (CHD), which can directly cause chest pain. In view of the urgency of chest pain, various hospitals have established chest pain centers, which are composed of cardiology and respiratory experts. Their core mission is to respond quickly and save the lives of patients with myocardial infarction.

Furthermore, respiratory diseases may also cause chest pain, especially when the lesions involve the pleura. For example, peripheral pneumonia may cause chest pain due to its proximity to the pleura; lung cancer, especially when the tumor involves the pleura or is accompanied by inflammation around it, is particularly painful; pneumothorax, that is, pleural rupture causing air to enter the chest cavity, is also a common cause of severe chest pain.

In addition, there are some rarer but equally serious causes of chest pain, such as aortic dissection, aneurysm, etc., which can also cause severe chest pain symptoms.

The cause of chest pain can be found quickly by asking about the patient's medical history and conducting a physical examination. For example, if a tumor is suspected, a chest X-ray can show the tumor and quickly identify the cause of the patient's chest pain. For example, if pneumothorax is suspected, a chest X-ray can show compressed lungs and air in the chest cavity. If chest pain is related to heart disease, basic examinations such as electrocardiogram and myocardial enzyme spectrum examination can basically quickly make a judgment.

2. Sudden cough and chest pain, what could be going on?

If you didn't have any pain before but now suddenly have a cough and chest pain, you might have pneumothorax, because pneumothorax can come on suddenly. For example, you may be fine if you just raised your hands, did pull-ups with both hands, or played basketball, which pulled you a little. If you have congenital developmental defects or are tall and thin, you may be prone to pneumothorax, which can occur suddenly and be very painful.

In addition, along with chest pain, breathing difficulties will soon occur. Because of breathing difficulties and lack of oxygen, the patient may even experience cyanosis and other symptoms. In the hospital, if you listen with a stethoscope and find that the breathing sounds are significantly weakened, you can basically make a preliminary judgment that it is pneumothorax.

How can a diagnosis be made? Taking a chest X-ray can clearly show that the lungs are compressed, the compression band can be seen, and the amount of air entering the chest cavity can be estimated. As long as the diagnosis can be made, pneumothorax is relatively easy to treat.

3. If chest pain is suspected to be caused by lung disease, what examinations should be done?

If you have simple chest pain and suspect it is lung disease, taking a chest X-ray is the simplest way to detect pneumothorax. If the chest pain is caused by lung cancer, it will usually be shown on the chest X-ray.

If abnormalities are found in the chest X-ray, such as tuberculosis lesions, the general tuberculosis site has flake-like shadows, cavities, or other nodular shadows, the next step is to do a further CT scan. CT can detect a lot of imaging information that the chest X-ray cannot provide.

Figure 2 Original copyright image, no permission to reprint

Let me remind you here that MRI is not used to check lung diseases because there is air in the lungs. Many people will ask, if CT scan is not clear, can MRI be used?

In fact, the role of MRI is very limited. However, if it is a disease of the large blood vessels in the mediastinum, MRI can be of great help, especially in determining whether there are lesions in the blood vessels, or the relationship between the lesions and the blood vessels. However, CT can also provide information in this regard.

4. Can sudden chest pain be relieved by patting the chest and back?

Regardless of the cause of chest pain, patting the chest is an irregular practice. Because whether it is chest pain caused by bronchial, lung, pleural diseases, or other causes such as heart disease, patting the chest has no benefit and may aggravate the chest pain.

For some reasons, such as back muscle strain or injury, massage may help, but it is not certain that, at least for respiratory diseases, patting is harmful rather than helpful.