Chest Tightness: Causes, Treatment & Help

Acute chest tightness is a distinctly painful and drastic experience for anyone affected. Its causes are varied and are sometimes accompanied by serious diseases. In the following, background information, treatments as well as approaches for living with its consequences will be presented. A feeling of tightness in the chest should not be confused with trepidation.

What is chest tightness?

Stabbing or tearing heart pain is described by most patients during a heart attack. The pain may radiate to the arms, neck, shoulder, upper abdomen, and back. Accompanying symptoms are usually: Shortness of breath, nausea, and anxiety (“fear of death”) accompanies. Chest tightness (angina pectoris) refers to an acute, seizure-like pain behind the breastbone. It often occurs under stress and is accompanied by a crushing to burning sensation. It is often not limited to the immediate heart region, but can radiate to the lower jaw, back or stomach region. The affected person usually experiences restlessness, anxiety and a devastating feeling. In addition, there may be accompanying nausea, vomiting and a cold, sweaty skin. Basically, two different forms can be distinguished:

Stable and unstable angina pectoris. Stable angina pectoris is characterized by the fact that it has already occurred before and a comparable event can be considered as a trigger. This could be, for example, a substantial meal, physical work or cold air. Unstable angina pectoris is when the trigger cannot be determined, the chest tightness occurs earlier than usual or is more intense than usual. A first-time attack can also be considered an unstable form. A special form is the so-called Prinzmetal angina, which can also occur at complete rest.

Causes

A feeling of tightness in the chest always occurs when the heart muscle consumes far more oxygen than is actually available to it. The result is reduced blood flow (ischemia), which is manifested by the symptoms described and, if prolonged, is associated with the death of heart muscle cells. Coronary artery disease (CAD) may be the underlying cause. CHD describes a metabolic and circulatory disorder of the coronary arteries often caused by vascular sclerosis. It is by far the most common cause of chest tightness. Acute or chronic heart failure, an effusion of the pericardial sac (pericardial effusion), arrhythmias and defects of the heart valves are also possible triggers. If the cause of the attack lies in the coronary vessels, it is called acute coronary syndrome. This can in turn be subdivided into myocardial infarction and unstable angina pectoris. A pain sensation similar to that of chest tightness can also occur in heartburn, biliousness, joint pain, gastritis, pneumonia and a variety of other clinical pictures. Accordingly, the diagnostic workup can be extensive.

Diseases with this symptom

  • Heart attack
  • Ischemia
  • Coronary artery disease
  • Angina pectoris
  • Heart failure
  • Pneumonia
  • Bronchitis
  • Anxiety disorder
  • Heartburn
  • Pulmonary embolism
  • Panic attacks
  • Reflux disease

Complications

Frequently, chest tightness subsides with reduction of exertion and disappears spontaneously after a few minutes. If this does not happen, even after taking nitroglycerin preparations, it may be a life-threatening condition. The greatest danger here is from a heart attack. The most feared complications are severe damage to the heart muscle (myocardium), failure of entire parts of the heart, and even death from heart failure. However, such an infarction does not always manifest itself as angina pectoris. It can occur almost unnoticed, especially in women, diabetics and the elderly. Arrhythmias or damage to vessels near the heart can also be potentially threatening and require appropriate treatment.

When should you see a doctor?

Medical attention is indicated whenever there is no improvement in chest tightness within a short period of time, the pain becomes unbearable, or it occurs in atypical situations.Stable angina pectoris, for example, always occurs during heavy exertion and accordingly disappears again at rest. In such a case, an emergency call must be made immediately and emergency medical treatment provided. However, definitive treatment can only be given in a hospital with a corresponding “Chest Pain Unit”, or with a cardiac catheter laboratory. Persistent shortness of breath or even changes in consciousness up to fainting are also justification for alerting an emergency physician. If the cause of the chest tightness is known, as in the case of gastritis, gastric ulcers (ulcus ventriculi) or reflux disease, for example, the general practitioner can refer the patient to a suitable gastroenterologist. The gastroenterologist can then perform a causal therapy, which should also eliminate the accompanying symptoms. In the case of the stable angina pectoris attacks mentioned above, those affected have usually been adequately informed by their attending physician and, if necessary, provided with an emergency medication (nitroglycerin). Nevertheless, in case of doubt or questions, the family doctor or, better yet, a cardiologist should always be consulted.

Diagnosis

The simplest and quickest diagnostic method available to the attending physician is the ECG (electrocardiogram). An occlusion of the coronary arteries can be detected quickly in this way, but it can also appear inconspicuous despite a manifest infarction. Rhythm disturbances can also be detected in this way. There are also long-term and stress ECG modifications that can be used to detect long-term and situation-dependent changes in cardiac output. For example, the reaction to cycling or climbing stairs can be tested in this way. Imaging techniques such as MRI, CT, sonography and PET scan can also be used and provide information on mechanical pumping and blood flow behavior. Angiography as well as angioscopy are available as invasive procedures, which allow a meaningful assessment of the coronary vessels. However, they require the insertion of instruments into the body, which is not completely risk-free. Coronary angiography simultaneously permits the treatment of vascular occlusion. In addition, ultrasound techniques exist in which the transducer is also introduced into the vessel during the cardiac catheterization and can thus provide additional important information. Damage to the heart muscle is usually also indicated by typical changes in special blood values, which are usually recorded in the clinics in such a case.

Treatment and therapy

Often, a heart attack is based on a narrowing of the coronary vessels, which is called arteriosclerosis. If such a narrowing is blocked by a blood clot, all subsequent heart muscle areas are no longer supplied with blood and oxygen. The heart muscle then dies within a few hours. Click to enlarge. A diagnosed vasoconstriction or even complete blockage can be removed in the course of a coronary angioplasty (PTCA). In this procedure, a small balloon is filled with fluid via an inserted cardiac catheter, which in turn dilates the blocked vessel. As a rule, a supporting wall (stent) is then inserted to prevent a new occlusion. If PTCA cannot be performed because the nearest center cannot be reached in a reasonable amount of time, a drug alternative exists. In this case, special lysing agents are introduced into the body via the veins. There they are directed to the blood clot responsible for the infarction and dissolve it. If the cause was only a temporary vascular spasm, then treatment is with physical rest, oxygen and nitroglycerin. Beta-blockers, aspirin and so-called statins are also used. They serve to reduce oxygen consumption at the heart and to improve the flow properties of the blood until the so-called spasm has resolved. Severe coronary artery damage must be surgically bypassed. This requires surgery at a center qualified to perform it. Other underlying diseases manifested by chest tightness are treated according to their cause.

Outlook and prognosis

The occurrence of a chest tightness can be understood as a warning signal.If the patient succeeds in eliminating harmful influences and consistently maintains changes in his behavior, the chances of a lasting improvement in his condition are good. If the onset of angina pectoris is due to a heart attack, the prognosis depends on a number of factors. First and foremost, however, the decisive factor is how quickly a definitive elimination of the circulatory disorder can be achieved. Other causes depend on how effectively the underlying disease responsible in each case can be treated.

Prevention

Coronary artery disease with chest tightness is the product of a variety of risk factors, which are influenced primarily by individual lifestyle. Critical factors here include unbalanced and high-fat eating habits, consumption of harmful substances (noxious agents), and irregular exercise. A varied diet with plenty of fruit, vegetables and fish, and little meat and fat, on the other hand, ensures a good ratio of LDL (low density lipids) to HDL (high density lipids) in the blood. Both represent types of fats, which, however, have different effects on the health of the vascular walls. Abstaining from tobacco and alcohol contributes to a more efficient heart, as does at least 30 minutes of exercise a day. In addition, stress should also be avoided wherever possible and any existing excess weight should be reduced. However, there is no definitive guarantee that this alone will prevent the development of coronary heart disease. Age, other diseases and hereditary predispositions also influence the development of CHD.

Here’s what you can do yourself

It is important in advance for the affected person to coordinate with his attending physician. Here it should be clarified which activities are still possible in the future and which could provoke further attacks. Once this has been done, private and social life should under no circumstances be restricted for fear of a renewed pain event. It is important to share fears, anxieties and worries with close people in order to prevent a depressive development. Professional psychological help can also be sought for this purpose. A possibly necessary change of diet can be made independently and adapted to one’s own preferences. The focus should always be on a balanced mixture. Vegetable oils should be preferred to animal products when cooking and attention should be paid to a sufficient supply of minerals, vitamins and high-quality proteins. For the sake of their own health, smokers should try to give up cigarettes, and the consumption of intoxicants of all kinds should be refrained from. If the own dwelling is to be reached only by laborious stair going, should be looked for a ground-level alternative. The patient should carry emergency medication with him/her when leaving the house and, if necessary, inform the person accompanying him/her. If the patient’s own working environment is characterized by stress, irregular rest periods or heavy physical strain, a change should be considered. Shift workers, managers or craftsmen are particularly affected by this. All these measures can contribute to an increase in personal well-being and reduce the likelihood of new chest attacks.