It is understandable that any person will become concerned when they feel pain in their chest. There are vital organs, like the heart and lungs, which lie in the chest and if these organs are severely damaged then it can lead to death. However, chest pain is not always due to a heart or lung problem. Sometimes the pain may arise from less serious causes like acid reflux or even muscle strain.
Pain is a warning signal that tissue is undergoing injury at damage. It is intended to prompt a person to take action where possible to remove the cause of this tissue injury and prevent further damage. However, it is not always clear where the pain is arising just based on its location. For example, chest pain can emanate from many of the different internal organs or even from the structures of the chest wall.
Nevertheless, pain should never be ignored and particularly chest pain. Sometimes the type of pain can help us to isolate a possible organ. For example, muscles may present with a cramping type of pain. However, this can still be confusing when it comes to the chest. The heart is a muscular organ and sometimes cardiac pain cannot be easily differentiated from pain of skeletal muscles that are on and in the chest wall.
Muscular Chest Pain
There are several muscles on the chest wall and in the chest cavity. The most significant of these muscles which may be mistaken for heart-related pain are the pectoral muscles (pectoralis major and minor) and the intercostal muscles. These skeletal muscles, which are under voluntary control, are easily strained and injured which may then cause pain (myalgia). This pain worsens with more severe muscle injuries, like a torn muscle.
Some of the possible causes include:
- Blow to the chest as may occur with a punch or motor vehicle accident.
- Strenuous physical activity like lifting heavy weights with the arms.
- Persistent coughing or repetitive vomiting.
- Fibromyalgia, infections and tumors.
Read more on chest muscle pain.
Signs of Muscular Pain
The following signs or symptoms are more likely to indicate skeletal muscle pain rather than cardiac pain:
- Pain that worsens with movements of the arms or deep breathing.
- Tenderness on certain areas of the chest wall.
- Weakness of the arms or difficulty inhaling deeply.
Heart-Related Chest Pain
The heart is constantly pumping to circulate blood throughout the body. It is able to do this because most of the heart is made up of muscle which contracts and relaxes continuously to achieve this pumping action. These muscles are smooth muscles which are not under voluntary control. It requires a steady supply of blood, namely through the coronary arteries, to ensure that the muscles are adequately nourish to continue functioning.
Some of the possible causes include:
- Angina pectoris
- Heart attack (myocardial infarction)
- Heart valve disease
Read more on chest heart pain.
Signs of Heart Pain
The following signs or symptoms are more likely to indicate cardiac pain rather than skeletal muscle pain:
- Central chest pain radiating to the arm, neck jaw particularly on the left side.
- Shortness of breath and difficulty breathing.
- Lightheadedness and dizziness.
Some of the other signs and symptoms that may arise in a heart attack includes:
- Nausea and sometimes vomiting.
- Excessive sweating
- Confusion and anxiety.
Differences Between Muscle and Heart Pain
It is important to differentiate between muscular pain and cardiac pain as the latter is often serious and can be life-threatening. Prompt medical attention is usually necessary for cardiac pain and can significantly impact on the prognosis.
However, it is not always easy to spot the difference between muscle pain and heart pain. It is therefore advisable to seek medical advice for any chest pain, particularly when there are accompanying symptoms like shortness of breath and dizziness.
Stress and Rest
Muscular chest pain can arise or worsen with physical strain but only if it involves using the arms (pectoral muscles) when breathing deeply (intercostal muscles). Heart pain on the other hand can arise with any physical or psychological stress. In conditions like angina pectoris the pain eases with rest but in a heart attack the pain does not relent with adequate rest.
Nitrates are drugs that help to widen the arteries of the heart (coronary arteries). These drugs are vasodilators and increases blood flow to the heart muscle. It therefore helps to relieve pain in conditions like angina pectoris. It may also provide some relief of chest pain in a heart attack but often cannot prevent the death of the heart muscle entirely.
*If chest pain eases with antacids then the pain is more likely due to digestive conditions like acid reflux.
Shortness of breath and difficulty breathing are characteristic signs of cardiac (heart) conditions. Since the heart cannot pump blood effectively, oxygen cannot be effectively distributed and this gives rise to shortness of breath. However, there may be some pain when inhaling and difficulty breathing deeply when the intercostal or pectoral muscles are strained and sore. This should not be confused with shortness of breath.
Read more on cardiac and non-cardiac pain.
Treatment of Muscle and Heart Pain
The treatment of muscular chest pain and cardiac pain differs significantly although the heart is largely muscular. It is important that the cause of the chest pain is first isolated by a medical professional. Firstly a clinical assessment by a medical doctor is necessary and then further tests may need to be conducted. This may require diagnostic investigations such as an ECG and angiography for heart conditions.
Medication like anti-inflammatory drugs, muscle relaxants and analgesics (painkillers) may help with easing pain of the pectoral muscles and intercostal muscles. Rest, cold and heat therapy and compression may also help. Treatment may also involve immobilizing the arms and physical therapy. Surgery may sometimes be necessary to repair torn muscles and/or tendons.
The treatment of cardiac pain is complex and can vary significantly depending on the underly heart conditions. Nitrates mentioned above are one type of drug that is used for conditions like angina or a heart attack. There are various other drugs like antihypertensives, blood thinners and clot-busting agents that may also be used. The choice of treatment of a cardiac condition needs to be done by a medical professional after thorough diagnostic investigations.