The first thing that strikes a person experiencing a chest pain is trouble with the heart. Chest pain causes a lot of anxiety in the patient as it is commonly related to heart attack or angina and people are quite aware of the serious consequences of the symptom.
However, it is important to be aware of the fact that not all times is a chest pain necessarily originating from or caused by diseases of the heart. There are plenty of other structures in the thoracic cavity and a systematic approach is needed to arrive at the correct diagnosis that reveals the real cause of the chest pain.
An analysis projects that in the US, 250,000 people experience sudden cardiac arrest each year, out of which 52 percent are women and shockingly only 5 percent survive. It is medically proven that women are less liable to get heart disease till menopause. Myocardial infarction or coronary artery disease (CAD) is very rare in menstruating women. Estrogen is said to confer a protective effect and prevents the development of atherosclerosis. However, as women start approaching menopause, the estrogen levels go down and with that the probability of development of CAD increases. However, there are lots of young to middle aged, menstruating women with complains of chest pain. Chest pain related to the heart or in other words cardiac pain or angina pectoris sends out retrosternal, poorly localized, heavy, compressive and squeezing feeling. It rarely lasts less than 1 minute or more than 20 minutes, unless it is a heart attack. Patients get prompt relief in less than 5 minutes on cessation of all activities or use of sublingual nitrates. Pain of a myocardial infarction is similar to the angina pain but is more pronounced and can last longer. Such pain is not be relieved by rest or sublingual nitrate and is further associated with palpitation, perspiration, nausea, vomiting, dizziness, blackout or even collapse.
Pain that is unlikely to be of cardiac origin is typically localized, sharp and piercing in nature and sometimes lasts less than 15 seconds. Pain of this kind mostly gets aggravated on deep inspiration and coughing. Reasons of chest pain could be associated to the dysfunction of valves. Mitral prolapse is a condition in which the leaflets of the mitral valve get prolapsed into the left atrium during systole. However, the real cause of this kind of chest pain lies unknown. The next category of valve disease is rheumatic valve disease. Mitral stenosis is a common rheumatic valve condition in females and can cause chest pain and dyspnea. The patient will have associated cough and experience low pitched rumbling diastolic murmur. Anxiety or depression is another very common cause of chest pain in the female gender. Many personal and social causes lead to anxiety, which results in various physical symptoms and those symptoms in turn cause more anxiety. Esophageal reflux is one of the most common causes of retrosternal pain. The pain gives a burning sensation, occurs more often in reclining posture and is relieved by assuming upright position. Esophageal spasm is a variety of the same disease. Sometimes peptic ulcer disease can also cause pain in the lower chest. Pulmonary cause of chest pain could be due to pulmonary embolism caused by deep vein thrombosis resulting from oral contraception usage. The pain is acute, severe and results in a critical condition. Pneumonia can also cause chest pain incase of pleural involvement. Tubercular involvement of the pleura is called pleurisy. The pain is sharp stab like, occurring on slightest act of breathing. Associated features are low grade fever, cough, and malaise, loss of appetite and loss of weight. Pain could also be neuromusculoskeletal in nature. The pain is very well localized, tender on touch, aggravated on deep inspiration and not aggravated on exertion.
Chest pain in a woman may have a range of reasons. Many a times, they are not of cardiac origin. Therefore, it is a must to go through extensive clinical examination and appropriate investigations before coming to the correct conclusion.
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