Chest pain is a symptom that frequently causes patients to seek medical care. The most common causes of chest pain are fairly benign, and do not require further medical attention. Chest pain combined with left arm pain is more worrisome, however, since this is a classic combination seen in dangerous types of heart disease. A patient's age, gender, medical history, other symptoms and certain lab tests are used to distinguish between benign and more serious causes. Only a doctor with all the information can determine the cause, so seeking medical attention is important.
The most common cause of chest pain results from strained muscles or inflamed cartilage in the chest, which is sometimes called "costochondritis." Depending upon the specific muscles involved, pain may be felt in other areas, such as the arms, shoulders or neck as well, according to "Harrison's Principles of Internal Medicine" by Dennis L. Kasper, M.D.
Typically, the pain begins with a sudden or unusual movement and often can be reproduced or increased by engaging in similar movements. Sometimes pressing in spots close to the affected muscle will intensify the pain as well. Musculo-skeletal causes of chest pain are almost never serious, and usually do not require treatment beyond rest, aspirin or Tylenol and warm compresses.
Angina occurs when narrowing of the arteries in the heart, known as coronary artery disease (CAD), causes a decrease in blood flow that is temporarily insufficient to meet the oxygen demands of portions of the heart muscle. "Harrison's Principles of Internal Medicine" reports that this temporary insufficiency may result from a transient increase in the narrowing of the arteries or from a temporary increase in the oxygen needs of the heart due to exertion.
Classically, angina causes a crushing-type pain in the chest that is often felt in the left arm and sometimes the jaw. Angina often occurs after some form of exertion, such as climbing stairs, but it can occur at rest and even when sleeping. The pain usually goes away after about five minutes, and improves with rest.
The classic description of angina was developed from studies of men, while women sometimes experience different symptoms. In addition, diabetics frequently have altered sensations of pain. So chest pain of any type that is accompanied by nausea, vomiting, shortness of breath or fainting can indicate angina, particularly in women or diabetics, notes "Harrison's Principles of Internal Medicine."
Angina is more likely in men, in patients older than 50 and in those with a history of risk factors for CAD, such as smoking, high blood pressure and high cholesterol. Angina is a serious disorder that requires medical attention, both for its own sake and because it indicates a dangerous degree of CAD.
"Harrison's Principles of Internal Medicine" further notes that a myocardial infarction (MI), or heart attack, occurs when CAD progresses to the point that areas of the heart are deprived of oxygen for long periods of time. This long-term lack of oxygen results in destruction of heart muscle cells and can lead to permanent heart damage or death.
The chest pain from an MI resembles that of angina, but it is usually more intense and does not go away after a few minutes.
It is also more likely to be accompanied by symptoms such as shortness of breath, nausea and excessive sweating. Obviously, an MI is a medical emergency that requires immediate attention.
Other Serious Causes of Chest Pain
There are several other conditions that can cause chest pain, some of them with serious or even fatal health consequences. While they may not necessarily cause pain in the left arm as well, such pain could be the result of another, unrelated condition.
A stabbing chest pain that radiates to the back, or a persistent chest pain that is accompanied by shortness of breath, fainting or a rapid heart rate should always be treated as an emergency requiring immediate medical attention.
- "Harrison's Principles of Internal Medicine"; Dennis L. Kasper, M.D.; 2005