There are many causes of chest pain, some of them serious. Here we look at some of the more common causes and their symptoms.

Words Dr Yvette Brindle

When we think of chest pain and exercise, many of us worry about the heart. There are many causes of chest pain, some of which are serious and some not. This article will take you through the most common causes of chest pain, and how and when to seek help.

Pinpointing the cause of chest pain requires a careful description of it. Let’s start by looking at one of the most serious causes of chest pain, cardiac chest pain.

Cardiac

Runners are often very in tune with their cardiovascular system, with some keeping track of their heart rate and recovery time. Cardiac chest pain is the one not to miss, as it could be a symptom of angina or even a heart attack.

Angina is a symptom of reduced blood supply to the heart muscle, most commonly caused by a build-up of fat within the blood vessels. A heart attack occurs when the blood supply is blocked to the heart muscle, starving it of oxygen. In angina, chest pain often relieves with rest, when the work and pressure on the heart is reduced.

When a heart attack occurs, rest may not relieve the pain, and the pain can be severe and prolonged. Here are some of the key characteristics of cardiac pain:

  • Dull or heavy in nature
  • Often described as a ‘tightness’
  • It may spread from the chest to the arms, neck or jaw
  • Often associated with nausea and difficulty breathing

Unfortunately, the symptoms of angina and heart attacks are not always classical. Some people do not experience pain at all. It is important we think about risk factors for cardiac chest pain to help make the diagnosis.

These include:

  • Smoking
  • Diabetes
  • High cholesterol
  • Obesity
  • High blood pressure

If you experience chest pain, which comes on when you run, and relieves when you rest, stop exercising immediately and book an appointment with your GP. This could be angina.

If you think you or someone else may be having a heart attack, call an ambulance immediately, especially if the pain is sudden and severe, with the characteristics mentioned above.

Respiratory

Chest pain may come from the lungs or respiratory system. There are lots of potential triggers here, but one of the most common is infection. Pneumonia is infection of the lungs.

Alongside the typical symptoms of cough and breathlessness, inflammation of the lung tissue can also lead to chest pain. Where infection affects the lining of the lungs, pleurisy develops. This causes chest pain on taking a deep breath or coughing. Suspect chest pain to be coming from the lungs if:

  • It is associated with difficulty breathing
  • The pains are worse breathing in or coughing
  • There is an associated cough or fever (symptoms of infection)

Chest infections are most common in those with underlying lung problems, such as asthma or chronic airways disease. They are more prevalent in smokers. Again, it is a diagnosis not to miss, and if you are worried, stop exercising and book an appointment with your doctor.

Gastrointestinal

Chest pain can often come from the digestive system. Symptoms of heartburn and acid reflux can be very difficult to distinguish from cardiac pain. Reflux of acid from the stomach can trigger inflammation and spasm in the lower gullet (oesophagus). This can typically produce a sharp, intense pain, which can come on suddenly. Inflammation in the stomach (gastritis) or stomach ulceration can also cause chest pain.

Some characteristics of chest pain that are more suggestive of a gastrointestinal cause include:

  • Pain which follows shortly after a meal
  • Associated belching or acid taste in the mouth
  • Pains worse on lying flat or bending over
  • Pains which are made worse with anti-inflammatories, such as ibuprofen

Some of the risks for developing heartburn or reflux include:

  • Being overweight
  • A diet rich in spicy food, caffeine, alcohol
  • Increased stress/ anxiety
  • Pregnancy

If you aren’t sure chest pain is coming from your digestive system, keep a low threshold for seeking help.

Musculoskeletal

This is a common cause of chest pain, especially in runners. Pain could be coming from the ribs, sternum (breastbone), shoulders, spine or any of the soft tissues and joints in between. Repetitive movement or unusually strenuous activity can trigger a problem. This type of pain tends be worse with exercise, movement or lifting and relieves with rest. Unfortunately, as our lungs don’t rest, pains coming from the ribs can often be slow to improve.

If your pain sounds like it is musculoskeletal, take some time off training. Look for any potential triggers. This pain can take a few weeks to improve, even when resting. Simple pain relief, such as paracetamol and ibuprofen can ease symptoms. Topical pain relief, which can be massaged into sore areas, is also helpful. If you have persistent musculoskeletal pain, see your GP. They may refer you on for physiotherapy.

Mental health

Often overlooked, anxiety can itself trigger chest pain. A panic attack is an extreme anxiety attack, when an individual may develop pains and palpitations in their chest. They may feel short of breath and develop tingling in their limbs. This can be frightening, and the symptoms are difficult to control.

Making a diagnosis can be difficult, and is often only made by exclusion of a physical cause through tests and investigations. The treatment may involve a combination of therapy and medication.

Take home messages

  • If you suspect cardiac chest pain, don’t delay in seeking help, it can be life-threatening.
  • Cardiac chest pain is more likely where there are risk factors present.
  • There are many causes of chest pain. The characteristics of the pain and associated symptoms help make the diagnosis.
  • Maintaining a healthy active lifestyle will reduce your risk of the serious causes of chest pain.

 

First published in Running Magazine, July 2016