Chest pain with covid

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Chest Pain and COVID-19: A Comprehensive Overview

Introduction: Chest Pain and COVID-19

Chest pain has emerged as a notable symptom during the COVID-19 pandemic, both as a direct result of the virus and as a consequence of related health behaviors. This article synthesizes current research on the prevalence, causes, and implications of chest pain in the context of COVID-19.

Increased Internet Searches for Chest Pain During COVID-19

During the COVID-19 pandemic, there was a significant increase in internet searches for chest pain, which correlated strongly with rising COVID-19 case numbers in the United States. This trend suggests that many individuals may have been self-triaging and seeking medical information online due to fear of contracting the virus in healthcare settings . This behavior is concerning as it may lead to delays in seeking professional medical care for potentially life-threatening conditions such as myocardial infarction or pulmonary embolism.

Chest Pain as a Symptom of COVID-19

Chest pain can be a direct symptom of COVID-19, although it is not among the most common symptoms. The virus can cause various types of pain, including chest pain, due to its impact on multiple body systems, including the cardiovascular and respiratory systems . Studies have shown that chest pain can mimic other serious conditions like pulmonary embolism, making it a challenging symptom for clinicians to diagnose accurately .

Post-COVID-19 Chest Pain

Many patients experience chest pain even after recovering from the acute phase of COVID-19. A systematic review and meta-analysis found that the prevalence of post-COVID chest pain ranged from 7.8% to 23.6% within the first year after infection . This post-viral chest pain is part of a broader spectrum of long-COVID symptoms, which also includes fatigue, breathlessness, and cognitive issues .

Chest Pain Following COVID-19 Vaccination

There have been reports of chest pain following COVID-19 vaccination, particularly with mRNA vaccines like BNT162b2. In a study conducted at a secondary hospital, 3.38% of patients presenting with chest pain post-vaccination were diagnosed with myocarditis, and 0.96% with pericarditis . Another study focusing on teenagers found that while confirmed myocarditis was rare, a significant number of patients showed mild myocardial abnormalities on cardiac MRI . Despite these findings, the majority of chest pain cases post-vaccination were non-cardiac in origin and resolved with conservative treatment.

Chest Pain in Specific Populations

Certain populations, such as individuals with pre-existing conditions like sickle cell disease, may experience chest pain as a complication of COVID-19. For instance, vaso-occlusive crises triggered by COVID-19 can lead to acute chest syndrome, a severe and painful condition .

Conclusion

Chest pain during the COVID-19 pandemic is a multifaceted issue, influenced by direct viral effects, post-infection sequelae, and behavioral changes in healthcare-seeking. While internet searches for chest pain have surged, indicating a potential delay in seeking professional care, it is crucial for individuals to understand that chest pain can signify serious conditions requiring immediate medical attention. Post-COVID chest pain and vaccine-related myocarditis, although relatively rare, highlight the need for ongoing monitoring and research to better understand and manage these symptoms.

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Internet search volume for chest pain during the COVID-19 pandemic

During the COVID-19 pandemic there has been a reduction in hospital admissions for acute myocardial infarction. This manuscript presents the analysis of Google Trends meta-data and shows a marked spike in search volume for chest pain that is strongly correlated with COVID-19 case numbers in the United States. This raises a concern that fear of contracting COVID-19 may be leading patients to self-triage using internet searches. Research Letter. During the COVID-19 pandemic, physicians worldwide have noted reductions in hospital admissions for emergencies including acute myocardial infarction and ischemic stroke. 1 , 2 Several explanations have been proposed including reduced air pollution, changes in diet and lifestyle, or, most worryingly, avoidance of hospitals to reduce the risk of COVID-19 infection. 3 There is significant concern that instead of presenting to hospital, fear of COVID-19 has led patients to self-triage using internet searches. Google Trends™ is a free publicly available tool that monitors how often search items are queried over time and provides insights into public health behavior. Recommendations for the documentation of Google Trends™ analyses have previously been published 4 and were consulted to facilitate reproducibility of the present study. We quantified searches in the United States (US) for the symptom of interest, chest pain, and the control terms toothache, abdominal pain, knee pain, heart attack and stroke (time period 1st Jan 2017 to 24th May 2020, accessed 28th May 2020, no quotation marks, no combination symbols, all query categories). Data on the number of COVID-19 cases per day in the US was retrieved from USAFacts.org, which collates data from government agencies and is used by the Centers for Disease Control and Prevention. Time-lag correlation analysis was performed using R. To assess the relationship between chest pain searches and COVID-19 caseload, data on search volume was also collected for the states with the highest and lowest numbers of COVID-19 cases. No extramural funding was used to support this work. The number of cases of COVID-19 in the US rose rapidly throughout March 2020 and during the same month the relative search frequency of the symptom chest pain, but not the control terms, nearly doubled compared to the previous three years (Figure 1A). There was a strong correlation between the number of new COVID-19 cases and Google search queries for chest pain (Pearson correlation coefficient 0.79 with 18-day time-lag) (Figure 1B). The search volume for chest pain also spiked in the states with the three highest (New York, New Jersey, Illinois), but not the three lowest (Hawaii, Montana, Alaska), COVID-19 caseloads (Figure 2). In this analysis we describe a strong correlation between the increase in COVID-19 cases and the utilization of Google for medical information. Chest pain is a common presenting symptom of life-threatening medical conditions including coronary artery disease, aortic dissection and pulmonary embolus, but is not a common symptom of COVID-19. 5 The analysis presented here suggests that the rise in COVID-19 cases has led patients to seek medical information about their symptoms from the internet at substantially higher rates compared to the previous three years. This does not appear to be due to generally increased search volumes nor seasonal variation (Figure 1). Within the US this was observed in states with a high prevalence of COVID-19 but not states with a low prevalence (Figure 2). This was despite all analyzed states instituting stay-at-home orders, which suggests this phenomenon is not related to lockdown restrictions. This raises a significant concern that in regions where caseloads are high, fear of contracting COVID-19 may be leading patients to self-triage, potentially in lieu of presenting to hospital. The rise in search volume for ‘chest pain’ but not ‘heart attack’ or ‘stroke’ may be explained by several hypotheses, including patients being more likely to search for symptoms rather than diagnoses, or it may reflect the reduced hospitalisations for these conditions during the COVID-19 pandemic and hence fewer patients receiving the diagnostic labels ‘heart attack’ and ‘stroke’. Indeed it was recently reported that the rate of catheter laboratory activation for ST-segment elevation myocardial infarction has decreased by 38% in the US compared to the pre-COVID-19 period, 1 and there have been similar reductions in hospital presentations for other life-threatening conditions such as acute aortic dissection. 6 This has been accompanied by a concurrent increase in out-of-hospital cardiac arrests 7 and, amongst patients that did present to hospital with acute myocardial infarction, increased rates of delayed presentation and complications. 8 While COVID-19 has a mortality of approximately 1%, 9 acute myocardial infarction in the absence of contemporary treatment has a one-month mortality of up to 50%. 10 As lockdown regulations begin to relax worldwide there is a significant risk of a second-wave of COVID-19, and so it is critical to re-emphasize to patients that internet searches are not an alternative to professional medical attention.

Rigorous Journal

2020·

20citations

·J. Ciofani et al.

American Heart Journal·

DOI

Vaso‐occlusive crisis and acute chest syndrome in sickle cell disease due to 2019 novel coronavirus disease (COVID‐19)

COVID-19 can trigger vaso-occlusive crises and acute chest syndrome in sickle cell disease patients, requiring immediate hospitalization and supportive care.

Case ReportRigorous JournalHighly Cited

2020·

86citations

·E. Nur et al.

American Journal of Hematology·

DOI

Time course prevalence of post-COVID pain symptoms of musculoskeletal origin in patients who had survived to SARS-CoV-2 infection: a systematic review and meta-analysis.

Almost 10% of SARS-CoV-2 patients experience musculoskeletal post-COVID pain symptoms during the first year after infection, with a decrease in prevalence from symptom onset to 30 days, an increase 60 days after, and a second decrease 180 days after infection.

Meta-AnalysisVery Rigorous JournalHighly Cited

2021·

103citations

·C. Fernández‐de‐las‐Peñas et al.

Pain·

DOI

Chest pain post anti-Covid-19 vaccination with mRNA BNT162b2 vaccine : the experience of a secondary hospital

Most chest pain after the BNT162b2 vaccine is non cardiac, with some cases of myocarditis or pericarditis, but no clinical significance was found.

2022·

1citation

·M. Stratinaki et al.

European Heart Journal. Acute Cardiovascular Care·

DOI

Characteristics of Teenagers Presenting with Chest Pain after COVID-19 mRNA Vaccination

Teenagers with chest pain after COVID-19 mRNA vaccination may have myocardial abnormalities, with older age and female sex being more vulnerable to these abnormalities.

Observational Study

2023·

1citation

·C. Park et al.

Journal of Clinical Medicine·

DOI

Chest pain mimicking pulmonary embolism may be a common presentation of COVID‐19 in ambulant patients without other typical features of infection

Chest pain mimicking pulmonary embolism may be a common presentation in COVID-19 patients without other typical features of infection.

Observational Study

2021·

6citations

·S. Harrison et al.

Journal of Internal Medicine·

DOI

Chest pain attendances to a Paediatric Emergency Department pre- and post-COVID-19 vaccination

Paediatric chest pain is largely non-cardiac in origin, and emergency department chest pain attendance rates and resource utilisation increased after the introduction of mRNA COVID-19 vaccination in adolescents.

Observational Study

2023·

1citation

·J. Tan et al.

Translational Pediatrics·

DOI

Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19

Long-COVID symptoms are more common and co-occur more frequently in COVID-19 survivors compared to influenza patients, with differences in incidence and co-occurrence based on sex, age, and illness severity.

Observational StudyRigorous JournalHighly Cited

2021·

771citations

·M. Taquet et al.

PLoS Medicine·

DOI

'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID

Doctors with long COVID experience a range of symptoms, including chest pain, breathlessness, fatigue, cognitive impairment, paraesthesia, muscle and joint pains, and a lack of support from healthcare systems.

Observational StudyHighly Cited

2021·

71citations

·A. Taylor et al.

Health Expectations : An International Journal of Public Participation in Health Care and Health Policy·

DOI

Pain Symptoms in Patients with Coronavirus Disease (COVID-19): A Literature Review

COVID-19 patients experience various pain symptoms, reflecting damage to different body systems, which can help doctors improve diagnosis and tailor targeted treatments.

Literature ReviewVery Rigorous JournalHighly Cited

2021·

98citations

·Lin-Man Weng et al.

Journal of Pain Research·

DOI

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