What Could Chest Pain Mean?

Pumping blood containing oxygen and nutrients to keep our body functioning, the heart is unquestionably one of the most important organs in our body.

With the increasing prevalence of heart disease in Singapore, it is important never to neglect symptoms such as chest pain, as it is the most common symptom of coronary artery disease.

The good news is not all types of chest pain is related to heart problems! Dr Ooi Yau Wei, cardiologist at Mount Elizabeth Novena Hospital, explains the possible causes of chest pain, how to tell if your chest pain is heart-related, and what you should do if you experience symptoms.

Heart-related causes of chest pain

• Coronary artery disease – when the blood vessels supplying blood to the heart muscles are blocked
• Myocardial infarction (heart attack) – when there is death of a portion of the heart muscle
• Myocarditis – inflammation of the heart muscle
• Mitral valve prolapse – when one of the heart valves fails to close properly
• Pulmonary embolism – when a blood clot is present in a major artery leaving the heart
• Aortic dissection – when there is a tear in a major artery leaving the heart

Non-cardiac causes of chest pain

Other than heart problems, chest pain may also be caused by problems arising from the stomach, lungs, bone, muscle or nerves. Here are some things a chest pain could mean:

1. Stomach problems

• Gastroesophageal reflux disease (GERD) – acid reflux in the stomach
• Peptic ulcers – sores due to a break in the lining of the stomach
• Oesophageal contraction disorders – spasms or high-pressure contractions in the gullet
• Gallstone disorders

How to tell: Common symptoms that accompany chest pain related to stomach issues include vomiting, stomach bloatedness or discomfort and a burning feeling arising in the stomach that radiates up the chest with a sour taste in the mouth.

2. Lung conditions

• Pneumonia – a lung infection
• Pneumothorax – where part of the lung collapses, releasing air into the chest cavity
• Pulmonary hypertension – where high blood pressure in lung arteries are stressing the right side of the heart

How to tell: Common symptoms that accompany chest pain related to lung issues include wheezing, shortness of breath, coughing and pain that worsens when taking a deep breath or coughing.

3. Bone, muscle or nerve injuries

• Rib fractures
• Muscle and tendon injuries

How to tell: Common symptoms that accompany chest pain related to a musculoskeletal injury include focal chest pain which worsens with deep breathing or coughing.

How to tell if your chest pain is heart-related

Heart-related chest pain is typically located in the central part of the chest just above the stomach. It usually feels like a squeezing or strangling sensation. It is often difficult to pinpoint the pain to one specific location, and the pain tends to radiate to the neck, jaw and left arm. In certain instances, it can radiate to the back.

The pain is usually aggravated by exertion, heavy meals and cold weather, while it tends to ease with rest. In some cases, especially in women, it can also come with symptoms like giddiness, tiredness, shoulder aches, nausea and vomiting.

When in doubt, always consult your family doctor or cardiologist.

How to tell when the chest pain signals a heart attack

Chest pain that arises due to a heart attack is typically more severe in intensity, may occur even at rest, does not get better with rest, and lasts more than 15 minutes. It is commonly accompanied by shortness of breath, dizziness, profuse perspiration and in some, a 'feeling of impending doom'.

What should you do if you experience chest pain?

If you experience chest pains, consult a family doctor or cardiologist as soon as possible. If severe, go to the nearest Urgent Care Centre​ (UCC) department where a heart attack can be ruled out rapidly with scans and investigations. If necessary, you will be referred to a specialist who will assist you in determining the cause of your chest pain.

Listen to your body and don't ignore symptoms of chest discomfort or aches.  Going for heart screening helps you identify hidden heart disease risks, so you can better prevent or treat heart disease.