Squeezing chest pain

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Understanding Squeezing Chest Pain: Causes and Implications

Common Causes of Squeezing Chest Pain

Acute Myocardial Infarction (AMI) Squeezing chest pain is a hallmark symptom of acute myocardial infarction (AMI), commonly known as a heart attack. This type of pain is often described as pressure, tightness, or a squeezing sensation in the chest and can radiate to the shoulders, arms, neck, jaw, or back . Women experiencing AMI may present with atypical symptoms such as dyspnea, weakness, and fatigue, which can complicate diagnosis.

Spontaneous Coronary Artery Dissection (SCAD) SCAD is a rare but serious condition that can cause sudden onset of squeezing chest pain. It involves a tear in the coronary artery wall, leading to a heart attack. This condition can occur in otherwise healthy individuals, including young women and athletes. For instance, a 45-year-old woman experienced acute substernal chest pain while cheering at a soccer game, which was later diagnosed as SCAD. Similarly, a 23-year-old bodybuilder developed squeezing chest pain after weight lifting, which was also attributed to SCAD.

Non-Cardiac Causes of Squeezing Chest Pain

Gastroesophageal Reflux Disease (GERD) GERD can mimic cardiac chest pain, presenting as a squeezing sensation in the chest, especially after meals. This type of pain is often intermittent and can be severe enough to interrupt normal activities. Unlike cardiac pain, GERD-related chest pain is not typically associated with exertion and may improve with proton pump inhibitors (PPIs).

Myocardial Bridging Myocardial bridging is a congenital condition where a coronary artery tunnels through the heart muscle, which can cause intermittent squeezing chest pain. Although often benign, it can lead to significant symptoms in some cases. A 48-year-old woman with a long history of intermittent chest pain was found to have myocardial bridging, which was managed conservatively.

Gender Differences in Chest Pain Presentation

Variations in Symptoms Men and women may experience chest pain differently. Men are more likely to report squeezing pain on the left side of the chest, while women may describe a dull pain in the retrosternal or epigastric areas. These differences can affect the diagnosis and management of conditions like obstructive coronary artery disease (OCAD). For example, in a study of Korean patients, men with OCAD were more likely to experience shorter duration pain and dyspnea, whereas women’s symptoms were less likely to be aggravated by emotional stress.

Diagnostic and Therapeutic Approaches

Electrocardiogram (ECG) and Cardiac Biomarkers The diagnosis of conditions like AMI often relies on typical changes in ECG and cardiac biomarkers. However, recognizing the impact of sex differences in symptoms is crucial for accurate diagnosis and treatment.

Coronary Angiography For patients with significant risk factors and typical chest pain, coronary angiography can be a definitive diagnostic tool. This procedure helps visualize the coronary arteries and identify issues like SCAD or myocardial bridging.

Conservative and Medical Management For non-cardiac causes or less severe cardiac conditions, conservative management with medications such as beta-blockers and calcium-channel blockers is often effective. In cases of myocardial bridging, surgical options are considered only when medical therapy fails.

Conclusion

Squeezing chest pain can be a symptom of various conditions ranging from acute myocardial infarction to non-cardiac issues like GERD. Understanding the nuances in symptom presentation, especially gender differences, is essential for accurate diagnosis and effective treatment. Diagnostic tools like ECG, cardiac biomarkers, and coronary angiography play a critical role in identifying the underlying cause, while treatment approaches vary based on the specific condition and its severity.