Dear Doctor,

Lately I have been experiencing a sharp piercing pain in my chest. I can’t tell what the problem is because I don’t have any other health issues. What could this be and how can I deal with it? Alice, 44

Dear Alice,

What is the site of the pain? Does it occur on exertion like walking, doing physical work, e.t.c. and stop when the work being done is stopped?

Chest pain can be due to multiple reasons at 44 years of age. It can simply be a musculoskeletal pain. This occurs due to undue stretching or rupture of the muscle fibers or other soft tissues present in the area. Any injury or severe stress as in undue stretching can cause it. In such case the pain can be mild or excruciating, depending on the extent of soft tissue stretch or trauma and usually occurs on movement. If needed, diagnosis can be made by scans. Commonly used pain killers give relief in musculoskeletal pain and even taking rest is helpful. Fracture of the ribs, also manifests as chest pain.

Functional dyspepsia or peptic ulcer disease or inflammation of the food pipe(esophagus) can cause a burning pain, usually occurring in middle of chest. It may be accompanied by nausea or vomiting. Hiatus hernia, where part of alimentary canal .pushes through the diaphragm, can also cause burning chest pain. These conditions can be diagnosed by upper gastro intestinal endoscopy. Treatment is by diet plans and medicines which block secretion of acid in the stomach.

Acute infections of the lungs like pneumonia lung abscess or pleuritis, present as chest pain on breathing in, along with breathlessness, productive cough, passing blood in phlegm, fever, e.t.c. symptoms. Chronic lung infections like T.B. of the lungs can cause a chronic pain. Diagnosis of these conditions is made by a blood test and X-ray of the chest. Herpes zoster(a viral infection) of any part of the chest causes severe chest pain, along with eruptions. It is diagnosed easily clinically.

The most sinister cause of sharp piercing chest pain is angina or coronary artery disease(CAD). Women become more prone to heart problems around menopause and after it, as protective effect of estrogen is withdrawn during menopause. Unlike men, women commonly develop coronary artery disease due to blocks in the small blood vessels of heart(Microvascular disease). Piercing, stabbing, type of chest pain can occur in the middle of chest, left side of chest, left shoulder, posteriorly on the left side of upper back, left arm radiating to wrist or index finger, e.t.c. sites, depending on site of block. It may be accompanied by breathlessness, sweating, nausea, vomiting, cold extremities, one or more of these symptoms. If the disease is neglected it can progress and affected part of the heart muscle can be damaged permanently, manifesting as a heart attack(acute myocardial infarction). This is a medical emergency and if not treated urgently can be fatal. Electroardiogram, cardiac echo, cardiac scans, treadmill test and angiography are various investigations employed to diagnose coronary artery disease and determine the site of block.

Apart from CAD, inflammation of any layer of the heart, infections or inflammation of the heart valves causes chest pain on exertion. Treatment of the heart condition consists of drugs to remove the clots, to open the blocked vessels and surgical intervention where necessary.