Forecast | Chest pain causes and therapy

Forecast

Depending on the causative clinical picture, a different prognosis of the cure can be assumed. The least dangerous chest pain is certainly caused by muscular and skeletal disorders and can usually be completely cured by pain medication or physiotherapy. Nowadays there is also a very good prognosis for cardiovascular diseases causing chest pain.

Chest pain is a common complaint that can have both harmless and life-threatening causes. One should therefore always assume that patients are in a dangerous situation. The best known cause of chest pain, even according to common opinion, is a heart attack, which is described as pain of destruction, previously the extent of the pain, with pulling in the left arm, upper abdomen and lower jaw.

The patients are scared to death, sweat and need air. An immediate hospitalization is urgently necessary. A preliminary stage of the heart attack is the angina pectoris attack (a narrowing of the vessels of the heart), which is divided into a stable course (only when moving) and an unstable course (when moving and at rest).

Unstable angina pectoris also represents an absolute emergency, as it is likely to lead to a heart attack. Here too, immediate cardiological monitoring is necessary. In addition to the heart, other organs of the thorax can cause chest pain.

A tear in the aorta leads to sudden, very severe pain, some of which radiates into the back. Sudden, severe, respiration-dependent pain accompanied by severe shortness of breath is indicative of a pulmonary embolism. Inflammation of the pleura also leads to breath-dependent tearing and pulling chest pain.

Inflammation of the pericardium, which is mostly viral, can also cause severe chest pain, but is usually accompanied by high fever. Overstretching and straining of the chest wall (intercostal neuralgia) or inflammatory cartilage changes between ribs and sternum (Tietze syndrome) can also cause chest pain, but this can usually be provoked and alleviated by appropriate movements. Orthopaedic diseases, such as Bechterew’s disease or chicken breast, can also cause sometimes very severe chest pain.

Tears in the oesophagus caused by alcoholism and frequent vomiting can also cause chest pain, as can inflammation of the gall bladder or pancreas, bloated intestines or reflux. If no organic causes of chest pain can be found, a psychosomatic form must be assumed. After mourning situations or during crisis situations, patients may experience chest pain without organic causes.

However, patients should also be referred to a specialist in psychiatry for psychiatric clinical pictures such as heart neurosis, depression, psychosis and hypochondria. In children between the ages of 12 and 14, chest pain occurs more frequently, but in most cases it is not organically caused. The cause often lies in stretching of the chest wall, intercostal neuralgia or hormonal influences.

Treatment is usually not necessary. Women and men are equally affected by chest pain, with women statistically suffering from the symptoms at a higher age. The peak of frequency lies between the ages of 45 and 65.

To make a diagnosis, the doctor should always first rule out a life-threatening cause, such as a heart attack or pulmonary embolism. Every patient with chest pain should therefore have an ECG and possibly a blood count taken, on which heart attack and pulmonary embolism can often be seen. If no cause is found, the abdominal organs, vessels and skeleton should be examined.

With a reflex hammer, the doctor can examine the sensitivity of the cartilage-bone boundaries (Tietze syndrome). By tapping the chest wall, he can determine intercostal neuralgia. It is important to note that patients whose overall situation becomes an emergency must be transferred to the clinic immediately and should only receive general first aid in the practice.

Once dangerous cardiovascular chest pain has been ruled out, with a little more rest, further causes can be looked for. If the doctor finds no organic causes, even after examining the heart by means of a stress ECG and ultrasound, a psychosomatic cause should be assumed as the reason and the patient should be calmed down and waited for accordingly or, if the patient is suffering too much, a specialist in psychiatry should be consulted. The disease causing the chest pain must be considered prognostically.

Certainly, the tension-inducing causes have the best prognosis and represent the least dangerous cause. Although the other causes are usually treatable, they are usually followed by months or even a lifetime of therapy and often have to be surgically removed. Chest pain due to psychosomatic causes has a relatively poor prognosis. This is due to the fact that the reason, cause and mechanism of origin are not precisely known and therefore cannot be treated in a targeted manner at first.