Dear Doctor,

I have never been asthmatic or suffered any breathing difficulty yet I have constant chest pain. What could be the problem?

Julius

Dear Julius,

There can be numerous reasons for chest pain. Heavy physical work, sudden jerky movements of arms as happens while playing active games like basketball or volley ball, can cause chest pain. This occurs due to stretching or tear of muscle fibers. Such pain is usually present over the site affected and is aggravated by movements.

Heart burn is a very common cause for chest pain. It is a burning kind of pain, usually located over middle of chest or left side, maybe aggravated by hunger or food intake. It may be associated with nausea and or vomiting and bringing out bitter yellow bile as reflux.

Herpes zoster is a viral infection that causes inflammation of the nerves and can occur anywhere in the body, including the chest. There is severe, excruciating pain followed by vesicular eruptions over the affected site. The infection clears by a week or so, but residual pain may occur till weeks or months later due to residual inflammation of nerves.

Left sided chest pain can be due to angina, when blood supply to the heart is momentarily cut off due to fat deposits occluding the lumen of the blood vessels. Here the pain is pressure like, comes while walking or working and is relieved on resting.

A young adult can have pain over the breast bone due to anxiety (costochondritis). Chest pain is also part of the manifestations of fibromyalgia, where there is stretching of muscle fibers due to stress or anxiety.

The underlying cause of chest pain can be easily diagnosed by clinical features. X-ray chest, electrocardiogram and C.T. scans can help to exclude underlying organic cause.

Treatment consists of treating underlying causes.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital