Chest tightness is a feeling of discomfort that occurs in an area between the upper abdomen and the neck. It may occur at any age and requires prompt attention. Most of you relate tightness in chest with a heart problem, but it is worth mentioning that there are other possible reasons if it. A few of them are serious and need immediate emergency medical call while others can be handled in an outpatient clinic.
Causes of Chest Tightness, How to Identify and Their Management
Angina Pectoris
In this condition, there is a sudden onset of pain and chest tightness due to narrowing of coronary arteries and insufficient blood and oxygen supply to the heart muscle.
How to identify
When you feel a sharp pain or a squeezing pressure behind your breastbone along with shortness of breath, light-headedness, palpitations, extreme fatigue and sweating then it is indicative of angina. The pain can radiate to your neck, shoulder, arm, jaw or back areas. It aggravates on strenuous activity, excitement or stress and usually goes away on rest.
What to do
You can prevent the episodes of angina by modifying your lifestyle. Avoid physical exertion, heavy meals containing fats and cholesterol, increased sodium in diet, excess anxiety and smoking. Increase your intake of fresh fruits and vegetables, legumes, beans, whole grains, poultry, and fish. Perform mild to moderate physical activity on a daily basis according to your doctor’s advice and stay healthy and fit. Do not forget to take your prescribed medications on time. These may include nitrates, calcium channel blockers, beta blockers, ACE inhibitors, cholesterol lowering medications, blood thinners or antiplatelet medications. In severe cases, invasive procedures such as angioplasty, coronary artery bypass grafting (CABG) or enhanced external counterpulsation (EECP) therapy are the possible solutions.
Heartburn
It is one of the leading causes of tightness in chest and occurs due to regurgitation of acid from the stomach to the esophagus.
How to identify
You may feel burning sensation and sticking of food in your throat or chest, nausea, vomiting, dry cough and abdominal pain accompanied by severe chest pain and tightness.
What to do
Your doctor may prescribe certain medications including antacids, H2 receptor blockers, and proton pump inhibitors to treat heartburn. At the same time, you are advised to avoid triggers such as smoking, alcohol, stress, fatty foods and lying down immediately after meals. Sometimes, surgical procedures are required to strengthen the lower esophageal sphincter and prevent acid reflux.
Heart Attack
It occurs when a section of your heart muscle die as the supply of oxygenated blood is cut due to coronary artery blockage or spasm. This is a life-threatening situation and needs emergency treatment.
How to identify
The signs and symptoms of heart attack may include severe crushing pain, difficulty in breathing, tiredness, nausea, dizziness and unusual sweating. In addition, your detailed medical history, family history, and certain investigations may aid in further diagnosis of the underlying problem. These may include measuring the blood troponin levels (CK or CK-MB), serum myoglobin levels or performing ECG, angiography and cardiac catheterization.
What to do
Treatment of heart attack requires making heart healthy lifestyle changes, which include lowering cholesterol levels, managing stress, lowering sodium intake, performing mild physical activity, quitting smoking and aiming for ideal body weight. Medications are almost similar to those given in angina pectoris which either increase the efficiency of the heart or unblock the coronary blood vessels. Other procedures that may help include
percutaneous coronary intervention, coronary artery bypass grafting, and pacemaker installation. Furthermore, cardiac rehabilitation program supervised by well-trained staff may also prevent the recurrence of heart attack.
Gallbladder Inflammation (Cholecystitis)
Cholecystitis due to gallstones, excessive alcohol use, infection or tumor may cause chest tightness.
How to identify
The pain begins in the upper abdominal area that may extend to the right shoulder, chest, and back. It aggravates on eating a fatty meal and during deep breathing. Other symptoms include heartburn, nausea, vomiting, chills, jaundice and clay colored stools.
What to do
You should avoid eating greasy and spicy food items. Furthermore, depending on the cause of gall bladder inflammation, your doctor may either give you medications or perform surgical procedure such as cholecystectomy to remove the gall bladder.
Asthma
In this condition, there is a narrowing of the airways due to inflammatory disease that may result in difficulty in breathing, wheezing and tightness in chest.
How to identify
Other symptoms of asthma may include coughing, nasal and chest congestion, shortness of breath, fever, and tiredness. Procedures such as chest x-ray, arterial blood gases, lung function test, allergen test, spirometry and others are required for definitive diagnosis.
What to do
Keep yourself away from factors or triggers that may precipitate asthma. Medications such as inhaled corticosteroids, inhaled B2 agonist, cromolyn sodium nebulizer, anti-IgE injection, leukotrienes and theophylline may help in relieving the symptoms of asthma.
Anxiety
Chest tightness preceding, accompanying or following a constant feeling of apprehension, loss of concentration, excessive fatigue and nervousness is the result of anxiety.
How to identify
Presentation of anxiety symptoms include muscular tension, shortness of breath, headache, palpitations, pounding of heart, profuse sweating and depression. It may occur due to the body’s flight or fight response to a stressor.
What to do
Management of anxiety consists of psychotherapy and prescription of certain medications. Stress management techniques, psychological counselling, cognitive behavior therapy, and cardiac monitoring assist in reducing the anxiety symptoms. The commonly prescribed medications may include antidepressants, benzodiazepenes, buspirone and selective serotonin reuptake inhibitors (SSRIs).
Costochondritis
This causes of tightness in chest is an inflammation of the cartilage that connects your ribs to the sternum leading to chest tightness and pain. It may occur due to trauma, viral or bacterial respiratory infections, and heavy exercise of arms and chest or without any known reason.
How to identify
When you experience stabbing pain around fourth, fifth and sixth ribs which increase on taking deep breaths, coughing or on movement then it is very likely that you have costochondritis. The pain is radiating type and can be felt in abdomen and back region.
What to do
Medical treatment of costochondritis includes anti-inflammatory drugs, corticosteroid injections and antibiotics. If there is no response to medications then your doctor may perform surgical treatment.
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