CHEST PAIN IN MIDDLE OF THE CHEST

 

    Chest pain is a common complaint reported in clinic practice by many patients. Chest pain can occur in the Centre of the chest or either sides of the chest or on the back side of the chest. Chest pain in the middle of the chest is an alarming symptoms because can be a sign of heart problem.

Heart attack

Sudden narrowing of the artery supplying artery leads to heart attack. It mostly effects smokers, diabetic patients, high blood
pressure patients and obese patients. Pain is likely to be associated with sweating or arm pain. It does not subside with antacids or pain killers. Pain cannot be localized to one particular area. It does not get aggravated by cough, deep inspiration or movement of the chest. This is of course most suspected cause for a chest pain. Though a serious condition, timely identification and treatment improve prognosis. An ECG should be done immediately. Emergency transfer to a hospital equipped with Cath lab is recommended. Patient need to take blood thinners immediately.

 

 

 

Aortic dissection

A tear occurs in the major artery of the body called aorta in aortic dissection. It causes severe chest pain in the middle of the chest and radiates to the back also. It is sudden in onset and very severe in intensity. It often effects high blood pressure patients who does not keep their blood pressure under control. It is an emergency. It needs
emergency surgery

 

 

 

 

Esophageal rupture, perforation

Rigorous straining or vomiting causes food pipe to tear or rupture. It causes very severe pain in the Centre of the
chest.  Prior retching is common. Pain is followed by fever.

 

 

Stable myocardial ischemia

Heart pain is considered stable when provoked by exercise, stress, emotion or sex. It is more of discomfort than pain. It often involves Centre of the chest. Patient may report breathlessness on climbing stairs or during strenuous activity. Pain subsides with sorbitrate tablet. ECG, 2D echo and TMT are necessary investigations to identify this condition

 

Pericarditis

Redness and edema of the pericardial sac (sac that surrounds heart) is called pericarditis. It is often caused by infection, drugs, kidney failure, and cancer. It causes pain in the Centre of the chest which gets aggravated by respiration or cough. Ecg and 2d echo are required to make the diagnosis. It often responds to pain killers or steroids

 

 

 

 

Gastroesophageal reflux disease

Reflux of stomach content to food pipe causes redness and edema which causes chest pain in the Centre region. Patients often responds to antacids. Pain occurs most commonly after having food.

 

 

Peptic ulcer disease

Ulcer in the stomach causes chest pain along with abdominal pain Pain worsens with eating. Belching, bloating sensation, nausea are other commonly associated findings. Endoscopy clearly identifies the location of the ulcer.

 

 

Esophagitis

Redness and edema of food pipe is called esophagitis. It can be caused by drugs, infections, or radiation injury. Endoscopy helps in the diagnosis of esophagitis

 

 

 

Musculoskeletal pain

 

Redness and edema of rib cage or chest muscles or various joints of chest cause musculoskeletal type of chest pain. Various causes are rheumatoid arthritis, Rib fractures, chest injury.Pain may occur in the center of the
chest. It is often provoked by taking deep breathing. It responds to pain killers.  X ray chest may suggest any fracture of ribs or any swelling in the ribs.

 

 

 

Panic attack/disorder

Panic attacks is an episodes of intense fear that begin abruptly and last for several minutes to an hour. One in four persons with a panic attack will have chest pain

 

 

 

Referred pain

Chest wall pain may be referred from painful disorders in other areas of body like abdomen.   Acute cholecystitis and pancreatitis may have referred pain that involves center region of the chest.

 

So far we have discussed about various causes of chest pain in the centre of the chest, detailed clinical history gives a lot of information for the diagnosis, Tests like ecg, 2d echo test, tmt test and endoscopy are advised accordingly