Doctor, My Chest Hurts

Chest pains accounts for a significant proportion of ER and doctor office visits. Evolving tests and protocols have resulted in reductions in fatalities from chest pain due to serious hereditary disease. Typically when we talk of chest pains, most people worry about heart attacks. There are, however, other serious conditions that can account for chest pains which will be determined by your healthcare provider. The large number of chest pain complaints tend to be due to benign conditions including chest muscle, bone pain and anxiety.

The problem, however, is though the symptoms and signs may be classic for some conditions, there is quite a bit of overlap of symptoms, which can make the initial diagnosis challenging. Your Primary Care Doctor and Emergency Providers are trained to identify specific risks, and in combination with tests, can determine with reasonable certainty what could be going wrong.

COMMON, BUT POTENTIALLY FATAL CHEST PAIN CONDITIONS
• Heart Attacks: People with a personal or a family history of heart attacks or early coronary disease, smoking, diabetes, hypertension, and high cholesterol should be concerned about chest pain.
• Blood Clots to Lungs (PE): A sedentary lifestyle, long distance travel including long plane rides, oral contraceptive use, smoking, cancers, and some genetic predispositions to forming clots which can run in families.
• Aneurysms: Smoking, a prior history of being a smoker, some genetic 
predispositions, hypertension, diabetes, and high cholesterol.
• Pneumothorax: Smoking, emphysema and chest trauma can lead to this condition. As noted, a common factor here is SMOKING!

TYPICAL SYMPTOMS
Though some symptoms described below are classic, it’s important to note that some don't have a classic presentation and particular groups like females and diabetics may have presentations that don't fit the norm and require a discerning eye! These particular symptoms are:
• Left-sided pain, which is worse during exertion and improves with rest. Symptoms typically include, nausea, "elephant sitting on my chest," vomiting, major sweats, shortness of breath, and pain going down the left arm or to the neck, jaws or back may indicate a coronary problem.
• Pain behind the sternum (breastbone) which is severe, sharp, and going between shoulder blades with dizziness and passing out may indicate an aneurysm.
• Pain with breathing, coughing up blood, and shortness of breath may indicate blood clots in the right settings.
Important: Call 911! Do not drive yourself to the ER with significant chest pain.

WHAT TO EXPECT
After a visit with your Primary Care Doctor or an ER Physician, they will recommend a treatment, but time is of the essence!! Aspirin and other medications including blood thinners may have to be given. An EKG and a chest x-ray are very useful tools in investigation. Blood tests like heart enzymes are done and in the right setting, CAT scans of the chest may be done. 

There are other medications that would be given depending on the conditions suspected. The ultimate treatment, which may include the latest procedures, will depend on your work up.

Dr. Kwame Says: Chest Pain complaints can be serious. They should not be ignored, especially if classic and the associations listed above exist. Some of you may have symptoms that develop over a period of time. Discuss your symptoms with your Primary Care Doctor and if you should have an acute problem, call 911.

Dr. Kwame Fiakpornoo is a Board Certified Internist/ Primary Care Doctor and Medical Director of CobbWest Internal Medicine Associates located in Dallas GA. Visit www.cobbwestim.com/ or call 678-324-7021 for more information.