General
Chest pain is feared by patients of all ages – if you associate it with problems with the heart, in the worst case a heart attack. However, chest pain or pulling in the chest does not always have to be associated with a heart attack; various other, relatively harmless causes can also play a role. In the case of chest pain, however, both the emergency doctor and the rescue service always assume the worst, as a heart attack is an absolutely life-threatening complication and must be treated as quickly as possible.
If chest pains occur, they should be taken seriously in any case. Of course, there can be chest pain where the cause is a clear event, such as an accident, or a sports injury. In all other cases, extreme caution is required.
If the chest pain also radiates into the left arm, the emergency services should be called immediately. Often affected persons ask themselves for an unnecessarily long time which doctor they should contact. A call to the rescue service with a description of radiating chest pain always results in the joint alerting of an emergency doctor.
This doctor also has the necessary means and medication available preclinically to combat a heart attack. If you look at chest pain in men, it can be attributed to a few large fields. First, the largest and most important field: cardiac complaints, speaks of heart attack, angina pectoris, and generally coronary heart disease (CHD).
Second, sports injuries, and traumatic events – i.e. chest pain caused by exogenous factors. And third, psychogenic chest pain, as a result of depression, or psychosis. The causes of the first field of chest pain in men, the cardiac problems, are typically stress, overexertion, and chronic diseases.
These include permanent high blood pressure, and unhealthy lifestyle. An unhealthy lifestyle is based on many different factors: obesity, smoking, high blood lipids, little exercise, a lot of stress, constant high blood pressure, little sleep, and psychological factors, to name just a few. The cause of coronary heart disease (CAD) is almost always due to the occlusion of a vessel that supplies the heart.
With every beat, the heart supplies not only the entire body with fresh, oxygen-rich blood, but also itself. The oxygen in the blood is needed to provide energy for muscle work, it is essential for survival. Without oxygen, muscle cells die, brain tissue perishes, and survival is impossible.
It is not for nothing that one of the maxims in emergency medicine is “supply every cell of the body with as much oxygen as possible”. If muscle tissue dies on the legs or arms, this is not too bad for the time being. But when you consider that the heart is a single large muscle, it quickly becomes clear why an untreated heart attack is always fatal.
The less muscle tissue is able to pump the blood into the body’s circulation, the less oxygen reaches the heart muscle, and the less muscle tissue is able to transport oxygen-rich blood – a vicious circle. But how does a heart attack occur, what are the concrete causes? High blood lipid levels lead to fat deposits in the blood vessels.
The physician speaks of arteriosclerosis. In addition to fat deposits, vascular constrictions can also be caused by thrombi, calcium and loose connective tissue. Human blood is extremely strict when it comes to foreign bodies in the vessels: as soon as something is discovered that does not actually belong in the bloodstream, a blood clot forms around the foreign body.
This is actually very useful when you think of injuries: After all, it prevents us from bleeding to death over every little thing. However, this circumstance has the consequence that small lumps form in the blood vessels, which are flushed with the blood flow until they eventually get stuck in a small vessel and then move it. Such a small vessel can be a coronary artery, for example.
Some coronary vessels can still be supplied by collaterals, but if these are also blocked over time, the perfusion of the corresponding supply area is reduced. Depending on the location, this is called anterior or posterior wall infarction, depending on whether the anterior or posterior wall of the heart is affected. This process manifests itself in the affected person through chest pain, shortness of breath, panic, and pulse acceleration.
The patients are scared to death. If the pain disappears again after 1-5 minutes, this is known as angina pectoris, or “chest tightness”. It is a harbinger of a heart attack, a warning shot.
Different stages of angina pectoris are classified according to whether the pain occurs at rest or during movement. Many patients always have a small pump spray with them especially for this case, which contains Nitrolingual. This is a drug that contains the chemical compound “nitroglycerin” – known as an explosive from various war films.
And the effect of Nitrolingual can be described in a similar way: It “blows up” blocked or cramped blood vessels again, thus ensuring sufficient blood flow to the adjacent vessels. The effect usually occurs within seconds. For chest pain that is located in the area of the heart and may radiate from the middle of the chest to the left (see: Chest pain left), the following always applies: Do not hesitate, alert the emergency services, every second counts.
An emergency doctor is automatically alerted as well. Special caution is required for women and diabetics, where the pain and radiation into the left arm may be completely absent. The second group of chest pain in men is traumatic or chronic pain.
Although a heart attack should never be ruled out for chest pain without prior examination, there are several causes that make other conditions more likely. One example of this is intercostal neuralgia: intercostal neuralgia is a pain syndrome in the intercostal region that typically causes stabbing chest pain. In this case, the nerves located between the ribs are compressed by various causes, resulting in pain.
Possible factors are irritation of the nerve root, herniated discs in BWS, rib fractures, malposition of the spine, herpes zoster (“shingles“), or more rarely: tumours. The nerve root compressed in this way causes a stabbing, persistent feeling of pain, especially when coughing or when inhaling, but this is not due to a cardiac event. The diagnosis is made by palpation and tapping various pressure points on the chest.
If these chest pains, which can clearly be triggered from the outside, are the cause, the diagnosis is relatively clear. Fractures, mainly of the ribcage, also fall into the same field. While fractures of individual ribs often go unnoticed, serial rib fractures usually cause severe pain.
These occur after sports injuries or accidents, the cause of the chest pain is then relatively clear. However, you can always have lice and fleas, as they say. A third group is the psychogenic chest pain.
They are common in men when they are under great stress or suffer from depression. This type of incubation pain is most ungrateful to the doctor, as he is on thin ice in every respect: On the one hand, there is always the possibility of a misdiagnosis, which the person affected will vehemently claim. On the other hand, one must try to let the patient retain his dignity, since the word “crazy” is always associated with the diagnosis “psychogenic”.
However, this is absolutely not the case: a lot of stress, both physical and psychological, can very quickly have an effect on the body. Psychosomatic illnesses are very common, and can affect all age and occupational groups. Unfortunately, in Germany the term is still associated with unnecessary shame.
Patients also feel that they are not taken seriously, as they actually experience the pain, and also feel great fear. It is important to recognise this illness as such and possibly to take a step backwards in their careers. In the long run, psychosomatic illnesses can also lead to manifest, actual illnesses. In any case, the doctor needs a special degree of sensitivity and tactical skills to be able to treat this form of chest pain.
