Chest pain that comes and goes
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Understanding Intermittent Chest Pain: Causes and Evaluation
Intermittent chest pain, which comes and goes, can be a concerning symptom for many individuals. This article synthesizes current research to provide a comprehensive understanding of the potential causes and recommended evaluation methods for this condition.
Common Causes of Intermittent Chest Pain
Gastroesophageal Reflux Disease (GERD) and Indigestion
One of the most common causes of intermittent chest pain is gastroesophageal reflux disease (GERD) or indigestion. This condition occurs when stomach acid flows back into the esophagus, causing a burning sensation in the chest. Factors such as smoking, alcohol consumption, coffee, fatty foods, and certain medications can exacerbate this condition. Symptoms often improve with antacid medications or milk.
Musculoskeletal Issues
Muscle strains and inflammation in the spaces between the ribs, known as costochondritis, can also cause chest pain. This type of pain is typically localized and can be reproduced by pressing on the affected area.
Respiratory Infections
Respiratory conditions such as pleurisy (inflammation of the tissue lining the lungs), bronchitis, and other chest infections can lead to intermittent chest pain. These conditions are often accompanied by coughing and other respiratory symptoms.
Cardiac Causes
Angina, a condition caused by reduced blood flow to the heart, is another potential cause of intermittent chest pain. Angina typically occurs during physical exertion, emotional stress, cold weather, or after eating a large meal. The pain is usually short-lived and subsides with rest. However, if left untreated, angina can lead to a heart attack, which is characterized by more severe and prolonged chest pain.
Evaluation and Diagnosis of Chest Pain
Clinical Guidelines
The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides a comprehensive framework for clinicians to assess and diagnose chest pain in adult patients. This guideline emphasizes an evidence-based approach to risk stratification and diagnostic workup, incorporating cost-value considerations and shared decision-making with patients.
Case Study: Noncardiac Chest Pain
A clinical scenario involving a woman with a six-month history of intermittent chest pain highlights the importance of thorough evaluation. Despite normal physical examination results and routine blood work, the patient experienced slight improvement with proton pump inhibitors (PPIs), suggesting a possible gastrointestinal cause. This case underscores the need for a detailed patient history and consideration of noncardiac causes when evaluating chest pain.
Conclusion
Intermittent chest pain can arise from various causes, including gastrointestinal issues, musculoskeletal problems, respiratory infections, and cardiac conditions. Proper evaluation and diagnosis are crucial for effective management. Clinicians should follow established guidelines and consider both cardiac and noncardiac causes to ensure comprehensive care for patients experiencing chest pain.
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