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Pathophysiology of Chest Pain - Myocardial Ischemia

Chest pain and discomfort in the chest is a common symptom that can arise in the lung disease, pleural, musculoskeletal diseases, disorders of the esophagus or other gastrointestinal disorders, or anxiety as well as in cardiovascular disease. The failure to recognize a serious disorder, such as ischemic heart disease, can lead to delays in treatment that is needed.

Causes of Chest Pain:

1. Heart-related Causes:

  • Angina: Chest pain or discomfort caused by reduced blood flow to the heart muscle.
  • Heart Attack (Myocardial Infarction): A sudden blockage in one or more coronary arteries, leading to heart muscle damage.
  • Pericarditis: Inflammation of the lining surrounding the heart (pericardium), causing chest pain that worsens with deep breathing or lying down.

2. Gastrointestinal Causes:

  • Gastroesophageal Reflux Disease (GERD): Acid reflux from the stomach into the esophagus can cause a burning sensation in the chest (heartburn).
  • Esophageal Spasm: Sudden, intense chest pain caused by abnormal contractions of the muscles in the esophagus.
  • Peptic Ulcer Disease: Sores in the lining of the stomach or small intestine can cause chest pain, especially after eating.

3. Respiratory Causes:

  • Pneumonia: Infection of the lungs can cause chest pain, especially when taking deep breaths.
  • Pleurisy: Inflammation of the lining around the lungs (pleura) can cause sharp chest pain that worsens with breathing.

4. Musculoskeletal Causes:

  • Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause chest pain, often exacerbated by movement or pressure on the chest.Muscle Strain: Overuse or injury to the muscles and tendons in the chest wall can cause chest pain.

5. Other Causes:

  •  Anxiety or Panic Attacks: Intense stress or anxiety can cause chest pain, palpitations, and shortness of breath.
  •  Rib Fracture: Injury to the ribs, such as from trauma or a fall, can cause chest pain, especially with movement or breathing.

 

Pathophysiology of Chest Pain - Myocardial Ischemia

Myocardial ischemia is the most common cause of cardiac chest pain and the most important in the identification to prevent complications, but it is more often perceived as a sensation of discomfort in the chest of the real pain. It is more often described as a dull pain, or a sensation of pressure, choked, pinched or drugged, rather than sharp or spasmodic pain. Patients often feel a sense of discomfort and not as a sensation of pain. Ischemia symptoms usually occur within 5 to 20 minutes, but can also last longer. Progressive symptoms or symptoms that occur at rest indicates unstable angina caused by heart plaque rupture or thrombosis. Protracted symptoms that indicate myocardial infarction, although one in three patients with acute myocardial infarction did not have chest pain. This pain is often accompanied by anxiety or restlessness. Location of pain is usually retrosternal or left precordial. Pain sometimes spread or located in the neck, lower jaw, shoulder, inner arm, upper abdomen or back and always involves the region of the sternum. The most frequent underlying cause of myocardial ischemia is obstruction of the coronary arteries by atherosclerosis. Transient episodes of myocardial ischemia are usually precipitated by the increased oxygen demand results from physical fatigue. Ischemic pain can also be caused by psychological stress, body heat, cold air, eating large amounts, or of the purpose of transporting oxygen due to anemia, hypoxia or hypotension. Pain in myocardial ischemia can also occur due to a combination of these factors and usually get better with rest, but sometimes do not fit that description. Pain not associated with a change in position or breathing. Myocardial infarction precipitation factor often not apparent.

Pain due to myocardial ischemia occurs when the oxygen supply to the heart is less in terms of the need for oxygen. Oxygen consumption is closely related to physiological efforts undertaken at the time of contraction and coronary venous blood normally experience desaturation much more than that flowing out from other areas of the body. Heart should mainly rely on the addition of coronary blood flow to gain additional oxygen.

In addition to state that narrows the coronary artery lumen, the only one that is often the cause of myocardial ischemia is nuisance such as aortic stenosis or hypertrophic cardiomyopathy, which causes striking disproportion between coronary perfusion pressure with oxygen requirement of the heart. Ventricular hypertrophy due to valvular heart disease, hypertrophic cardiomyopathy or hypertension may predispose to myocardial ischemia due to interruption of blood flow from the penetration of epicardial to endocardial coronary arteries. Both ventricles and the aorta can also cause ischemic pain or pain with a less distinctive picture. Myocarditis, cardiomyopathy, primary pulmonary hypertension, and prolap mitral valve associated with atypical pain in angina pectoris. Aortic dissection is a classic cause severe pain and immediately radiating to the back.
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