Pain and pressure can be grouped together under the broad heading of chest discomfort. There are many things that cause chest discomfort. However, the most concerning reasons that can cause chest discomfort during exercise include angina and heart attack. Because angina is typically thought of as the precursor to a heart attack, and a heart attack can kill you, if you are experiencing chest pressure during exercise, it is important to see your doctor as soon as possible.
Chest Discomfort
According to Medline, there are many different causes of chest pain. The most concerning of these are life-threatening causes, including heart attack, dissecting aortic aneurysm, pulmonary embolus and perforated ulcer. Other causes of chest discomfort include pneumonia, musculoskeletal strain, anxiety and gastroesophageal reflux. However, there are relatively fewer causes of chest pain that occur during exercise, and only a few of these are regularly described as "pressure-like."
Chest Pressure During Exercise
If you are experiencing chest pressure during exercise, an acute coronary syndrome must be ruled out. Acute coronary syndromes encompass a continuum of problems with your heart, ranging from stable angina, which typically presents with chest pressure only on exertion, to unstable angina, which presents either with worsening chest pressure with exertion, or chest pressure at rest, and a myocardial infarction, or heart attack, which presents like unstable angina but is much more serious.
Pattern
According to Thomas Lee in "Harrison's Principles of Internal Medicine," a typical pattern for chest pressure during exercise that is medically concerning is centralized pressure -- also known as substernal -- that begins with exercise and stops with rest. This pressure may be accompanied by other symptoms, including sweating, shortness of breath or pain radiating up to your jaw or down your right arm. This constellation of symptoms is most concerning for heart attack.
Mechanism of Heart Attack
According to Christophe Depre and colleagues in "Hurst's The Heart," when cholesterol plaques formed in the arteries supplying your heart with blood rupture it can trigger a heart attack. These plaques can form if you eat a diet high in cholesterol. After rupturing, the exposed inner plaque serves as a surface on which blood can clot. When a clot forms, blood flow to tissues beyond the clot is prevented, and those tissues can become injured or die.
Tests and Treatment
To determine whether or not you've had a heart attack, and to direct treatment, your doctor will ask you to describe your symptoms, and will perform a physical exam. They will also likely obtain an electrocardiogram, or EKG, which is an electrical representation of how well your heart is functioning. Treatment for a heart attack will likely involve medications designed to decrease stress on your heart, and in serious cases may involve radiologically-guided catheters fed into the arteries to supply your heart, which are used to break up the clots formed by ruptured atheromas.
References
- "Harrison's Principles of Internal Medicine"; Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Joseph Loscalzo (editors); 2008
- Medline Plus: Chest Pain
- "Hurst's The Heart"; Valentin Fuster, Robert A. O'Rourke, Richard A. Walsh, Philip Poole-Wilson (editors); 2008
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