The Dangers Of Chest Pain
Accounting for 8 million visits annually to the emergency room, chest pain is a common complaint. The causes are varied and include cardiac, gastrointestinal (GI), musculoskeletal, pulmonary, and infectious. A life-threatening cause, such as a heart attack or pulmonary embolism (PE), should prompt immediate medical attention. Here are a few chest pain warning signs that should elicit immediate medical attention.
1. Sudden, sharp, and stabbing
Chest pain that commences suddenly, is sharp and stabbing, and radiates to the left arm, shoulder, neck, or jaw, is a harbinger of an acute ischemic event. Oftentimes, patients will suddenly report squeezing and diaphoresis or sweating. Ischemia refers to a lack of blood flow and oxygen to a coronary vessel in the heart. A heart attack occurs from plaque buildup in the artery, which causes narrowing and reduced blood flow, leading to angina pectoris. When the plaque ruptures, a blood clot can produce a complete blockage. If this happens, the longer the tissue is oxygen-deprived, the higher the chance for irreversible damage. Rapid emergent evaluation is critical in an emergency department to receive percutaneous coronary intervention (PCI) or a non-surgical procedure to open the artery and restore blood flow.
2. Severe shortness of breath
Chest pain associated with severe shortness of breath can be an ominous sign related to a pulmonary embolism or blood clot in the lungs. A PE can restrict blood flow to the lungs, hampering oxygen levels and placing strain on the heart. The most common symptom is tachypnea or rapid breathing of over 20 breaths per minute. PE occurs at an incidence of 1.15 per 1,000 people in the US and has a 25% mortality rate. Emergency evaluation to confirm the diagnosis requires a computed tomography angiography (CTA), and treatment involves either anticoagulation or blood thinning medications and thrombolysis or clot-busting medications.
3. Ripping pain in the back
Aortic dissection (AD) is a life-threatening condition in which the inner layer of the aorta, the body’s main artery, tears away from the middle and outer layers. This creates a false channel within the aorta, which can cause blood to flow outside the artery. Symptoms like fainting, pain, shortness of breath, and difficulty walking can occur. Risk factors include hypertension (HTN) and smoking. AD occurs in about 2 out of every 10,000 people and is more common in men. Mortality rates in aortic dissection for the first 48 hours are 0.5% per hour. Diagnosis is typically achieved through rapid imaging involving a computerized tomography (CT) scan of the chest with intravenous (IV) contrast. Treatment necessitates rapid evaluation and repair by a cardiothoracic surgeon.
Recognize the signs of a medical emergency
Chest pain is a common complaint in the emergency room (ER) with many causes, ranging from benign to life-threatening. While many cases of chest pain may not require immediate medical attention, recognizing the signs and symptoms of a serious condition that warrants an emergency room visit is paramount. Sudden onset of chest pain with radiation to the neck, jaw, or shoulder requires immediate medical attention. Chest pain associated with sudden shortness of breath and rapid breathing is another sign. Ripping pain traveling to the back is another indicator that should provoke an ER visit or 911 call.
