Chest heaviness
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Understanding Chest Heaviness: Causes and Diagnostic Approaches
Introduction to Chest Heaviness
Chest heaviness is a common symptom that can be indicative of various underlying conditions, ranging from benign to life-threatening. It is crucial to understand the potential causes and appropriate diagnostic methods to manage this symptom effectively.
Cardiac Causes of Chest Heaviness
Acute Coronary Syndrome and Myocardial Infarction
One of the primary concerns with chest heaviness is the possibility of acute coronary syndrome (ACS) or myocardial infarction (MI). A case study of a 38-year-old man with central chest heaviness at rest revealed elevated troponin levels and normal echocardiography, leading to a diagnosis of ACS after coronary angiography 1. Similarly, a 66-year-old man with long-standing intermittent chest pain experienced increased frequency of symptoms, which were suggestive of ischemic heart disease despite unremarkable previous evaluations 10.
Non-Ischemic Cardiomyopathy
Chest heaviness can also be a symptom of non-ischemic cardiomyopathy. For instance, a 66-year-old female with hypereosinophilic syndrome (HES) presented with chest heaviness, which was part of a broader symptom complex including weakness and shortness of breath 3.
Coronary Artery Anomalies
Anomalous coronary arteries can present with chest heaviness. A 39-year-old man with exertional chest discomfort and heaviness was found to have an anomalous right coronary artery originating from the left anterior descending artery 6. Another case involved a 60-year-old man with exertional chest heaviness, which led to the discovery of a split circumflex coronary artery 9.
Non-Cardiac Causes of Chest Heaviness
Pulmonary and Mediastinal Conditions
Chest heaviness can also be associated with pulmonary or mediastinal conditions. A 26-year-old man with Hodgkin lymphoma presented with chest heaviness, which was later attributed to mediastinal enlargement detected via ultrasound 7.
Pseudoaneurysms
A rare cause of chest heaviness is a pseudoaneurysm. A 69-year-old woman with no significant medical history presented with chest heaviness, and imaging revealed a large paracardiac mass, diagnosed as a right coronary artery pseudoaneurysm 4.
Diagnostic Approaches
Electrocardiography (ECG) and Holter Monitoring
ECG is a fundamental tool in evaluating chest heaviness. In a case involving a 56-year-old man, daily episodes of chest heaviness were investigated using a 24-hour Holter monitor, which showed T-wave inversions inconsistently associated with symptoms 2. This highlights the importance of continuous monitoring in capturing transient cardiac events.
Echocardiography and Stress Testing
Echocardiography is essential for assessing structural heart disease. In the same 56-year-old patient, echocardiography showed no structural abnormalities, and an exercise nuclear stress test indicated normal perfusion 2. These tests help rule out significant ischemic heart disease.
Coronary Angiography
Coronary angiography remains the gold standard for diagnosing coronary artery disease. It was pivotal in diagnosing ACS in the 38-year-old man with elevated troponin levels 1and in identifying minimal coronary artery disease in the 56-year-old patient with T-wave inversions 2.
Conclusion
Chest heaviness is a multifaceted symptom with a broad differential diagnosis. Cardiac causes such as ACS, non-ischemic cardiomyopathy, and coronary artery anomalies are significant considerations. Non-cardiac causes, including pulmonary conditions and pseudoaneurysms, should also be evaluated. A comprehensive diagnostic approach, including ECG, Holter monitoring, echocardiography, stress testing, and coronary angiography, is essential for accurate diagnosis and management. Understanding these diverse etiologies and diagnostic tools can aid in the effective treatment of patients presenting with chest heaviness.
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Most relevant research papers on this topic
Chest pain: when in doubt…
Acute coronary syndrome is diagnosed when chest pain persists for more than a few hours, is associated with elevated troponin I levels, and is associated with a history of mild abdominal discomfort.
Case Report
Rigorous JournalChest Pain and T-Wave Inversions in a 56-Year-Old Man.
T-wave inversions in a 24-hour Holter monitor may indicate Wolf-Parkinson-White syndrome, but their cause remains unclear.
Case ReportRigorous JournalHYPEREOSINIOPHILIC SYNDROME CAUSING NONISCHEMIC CARDIOMYOPATHY
Hypereosinophilic syndrome (HES) can cause nonischemic cardiac muscle pain, and its diagnosis requires careful clinical history and laboratory tests.
Case Report
Very Rigorous JournalOverlapping-Stent Intervention Treatment of a Giant Right Coronary Artery Pseudoaneurysm.
Angiography revealed a giant right coronary artery pseudoaneurysm, and overlapping-stent intervention was recommended for treatment.
Case ReportLetter by Jiang and Qiao Regarding Article, "Chest Pain and T-Wave Inversions in a 56-Year-Old Man".
Chest pain and T-wave inversions in a 56-year-old man with Wolf-Parkinson-White syndrome after radiofrequency ablation may be related to cardiac memory.
Case ReportRigorous JournalAnomalous right coronary artery from the proximal left anterior descending artery: a rare finding and its clinical significance.
Anomalous right coronary artery from the proximal left anterior descending artery is a rare and potentially life-threatening condition.
Case ReportHeaviness in the chest and Hodgkin Lymphoma: An unusual presentation
Hodgkin lymphoma can present as mediastinal enlargement in healthy individuals, making it an unusual presentation for chest heaviness.
Case ReportBilateral origin of a split circumflex coronary artery
Bilateral origin of a split circumflex coronary artery was found, suggesting a possible ischemic origin of the left main coronary artery.
Case Report66-year-old man with long-standing intermittent chest pain.
Long-standing intermittent chest pain in a 66-year-old man increased in frequency from once a week to daily within 6 months, with relief occurring after 90 seconds of rest.
Case Report