The acute chest tightness is an extremely painful and drastic experience for everyone concerned. Their causes are varied and sometimes go hand in hand with serious illnesses. In the following, backgrounds, treatments and approaches for life and their consequences will be shown. A Chest tightness should not be confused with anxiety.
Sharp or tearing heart pains are described by most patients during a heart attack. The pain can radiate to the arms, neck, shoulders, upper abdomen and back. Accompanying symptoms are usually: shortness of breath, nausea and a feeling of fear ("fear of death").
Chest tightness (angina pectoris) describes an acute, attack-like pain behind the breastbone. It often occurs under stress and is accompanied by an overwhelming or burning sensation. Often its area is not limited to the immediate heart region but can radiate into the lower jaw, back or stomach region. The person affected usually experiences restlessness, fear and a devastating feeling. In addition, nausea, vomiting and cold, sweaty skin can also occur.
There are basically two different forms:
The stable and the unstable angina pectoris. Stable angina pectoris is characterized by the fact that it has already occurred and a comparable event is a possible trigger. This can be, for example, an extensive meal, physical work or cold air.Unstable angina pectoris occurs when the trigger cannot be determined, the chest tightness occurs earlier than usual or more intensely than usual.
A first-time attack can also be rated as an unstable form. A special form is the so-called Prinzmetal angina, which can also occur in complete calm.
Chest tightness always occurs when the heart muscle uses far more oxygen than is actually available. The result is a reduced blood flow (ischemia), which manifests itself in the symptoms described and, if stopped for a long time, is associated with the death of heart muscle cells.
Coronary heart disease (CHD) can be the cause. CHD describes a metabolic and circulatory disorder of the coronary arteries, often caused by vascular sclerosis. It is by far the most common cause of chest tightness. Acute or chronic heart failure, an effusion of the pericardium (pericardial effusion), arrhythmias and defects in the heart valves are possible triggers.
If the cause of the attack lies in the coronary arteries, it is called acute coronary syndrome. This in turn can be divided into heart attack and unstable angina pectoris. A sensation of pain similar to that of chest tightness can also arise with heartburn, gallbladder problems, joint pain, inflammation of the gastric mucosa (gastritis), pneumonia and a variety of other diseases. The diagnostics can therefore be extensive.
Often the tightness of the chest decreases when the load is reduced and disappears spontaneously after a few minutes. If this does not happen, not even after taking nitroglycerin preparations, it may be a life-threatening condition.
The greatest danger comes from a heart attack. Dreaded complications here are severe damage to the heart muscle (myocardium), failure of entire parts of the heart, or death from heart failure. However, such an infarction does not always have to be expressed by angina pectoris. It can go almost unnoticed, especially in women, people with diabetes and the elderly. Arrhythmias or damage to blood vessels close to the heart can also be potentially threatening and require appropriate treatment.
Medical help is always indicated if there is no improvement in chest tightness within a short time, the pain becomes unbearable or occurs in atypical situations. Stable angina pectoris always occurs when there is a lot of stress and accordingly disappears again when the patient is at rest.
In such a case, an emergency call must be made immediately and emergency medical treatment given. However, the definitive treatment can only be provided in a clinic with a corresponding “Chest Pain Unit” or with a cardiac catheter laboratory. Another justification for alerting an emergency doctor is persistent shortness of breath or even changes in consciousness up to and including fainting.
If the cause of the tightness of the chest is known, such as an inflammation of the stomach lining, gastric ulcer (gastric ulcer) or reflux disease, the family doctor can refer you to a suitable gastroenterologist. This can then undertake a causal therapy, with which the accompanying symptoms should also disappear.
In the case of the stable angina pectoris attacks mentioned, those affected are usually adequately informed by their attending physician and, if necessary, given emergency medication (nitroglycerin). Nevertheless, if in doubt or if you have any questions, you should always consult your family doctor or, even better, a cardiologist.
The ECG (electrocardiogram) is the easiest and fastest diagnostic method available to the attending physician. A blockage of the coronary arteries can be detected quickly, but it can also appear inconspicuous despite a manifest infarction. Rhythm disorders can also be detected in this way.
There are also long-term and stress ECGs as modifications, with which long-term and situation-dependent changes in the heart currents can be recorded. For example, the reaction to cycling or climbing stairs can be checked. Imaging methods such as MRT, CT, sonography and PET scan can also be used and provide information about the mechanical pumping work and the flow behavior of the blood.
Angiography and angioscopy are available as invasive procedures, which allow a meaningful assessment of the coronary vessels. However, they do not require the introduction of instruments into the body in a completely risk-free manner. At the same time, coronary angiography allows the therapy of a vascular occlusion.
In addition, there are ultrasound techniques in which the transducer is also inserted into the vessel during the cardiac catheter examination and can thus provide additional important information. Damage to the heart muscle is usually also indicated by typical changes in special blood values, which are normally recorded in the clinics in such a case.
A heart attack is often caused by a narrowing of the coronary arteries, which is known as arteriosclerosis. If such a constriction is blocked by a blood clot, all subsequent heart muscle areas are no longer supplied with blood and oxygen. The heart muscle then dies within a few hours. Click to enlarge.
A diagnosed vascular narrowing or even the complete occlusion can be removed with a coronary angioplasty (PTCA). Here, a small balloon is filled with fluid via an inserted cardiac catheter, which in turn expands the closed vessel. As a rule, a supporting wall (stent) is then inserted to prevent a new closure.
If PTCA cannot be carried out because the next center cannot be reached within a reasonable period of time, there is an alternative medicinal product. Special lysing agents are fed into the body through the veins. There they are guided to the blood clot that is responsible for the infarction and dissolve it.
If the cause was only a temporary vascular spasm, the treatment is given with rest, oxygen and nitroglycerin. Beta blockers, aspirin and so-called statins are also used. They serve to reduce the oxygen consumption in the heart and to improve the flow properties of the blood until the so-called spasm has resolved itself.
Serious damage to the coronary arteries must be surgically bypassed. This requires an operation in a qualified center. Other underlying diseases that manifest themselves as chest tightness are treated according to their cause.
The appearance of chest tightness can be understood as a warning sign. If the sick person succeeds in eliminating harmful influences and consistently maintaining changes in his behavior, the chances are good for a permanent improvement in his condition.
If the occurrence of angina pectoris is based on a heart attack, the prognosis depends on a number of factors. The most important thing, however, is how quickly the circulatory disorder can be finally eliminated. Other causes depend on how effectively the underlying illnesses responsible can be treated.
Coronary artery disease with chest tightness is the product of a multitude of risk factors, which are mainly influenced by the individual lifestyle. Above all, unbalanced and high-fat eating habits, consumption of harmful substances (noxae) and irregular exercise are critical here.
A varied diet with lots of fruit, vegetables and fish, as well as little meat and fat, on the other hand, ensure a good ratio of LDL (Low Density Lipids) to HDL (High Density Lipids) in the blood. Both represent types of fats, which, however, have different effects on the health of the vascular walls.
Quitting tobacco and alcohol as well as at least 30 minutes of exercise a day contribute to a more efficient heart. In addition, stress should be avoided wherever possible and excess weight should be reduced. However, there is no definitive guarantee that no coronary heart disease will develop. Age, other illnesses and hereditary predispositions also have an influence on the development of CHD.
It is important for the person concerned to coordinate with his treating doctor in advance. This should clarify which activities are still possible in the future and which could provoke further attacks. Once this has happened, private and social life should by no means be restricted out of fear of another painful event. It is important to share fears, fears and worries with loved ones in order to prevent depressive development. Professional psychological help can also be obtained for this purpose.
If you need to change your diet, you can do it yourself and adapt it to your own preferences. The focus should always be on a balanced mix. Vegetable oils should be preferred to animal products when cooking and a sufficient supply of minerals, vitamins and high-quality proteins should be ensured.
For the sake of their own health, smokers should try to give up cigarettes and the consumption of intoxicants of all kinds should be avoided. If your own apartment can only be reached by laboriously walking upstairs, you should look for an alternative at ground level. The sick person should carry emergency medication with him when leaving the house and, if necessary, inform his companion about it.
If your own work environment is characterized by stress, irregular rest periods or heavy physical strain, a change should be considered. This mainly affects shift workers, managers and craftsmen. All of these measures can contribute to an increase in personal well-being and reduce the likelihood of new chest tightness attacks.