Chest Pain

 An intriguing question that has puzzled both physicians and the lay public concerns the relationship between injury to an internal organ and the sensation of that injury perceived by patients as arm, chest, back, or jaw pain. The transmission of the pain impulse from the heart to the brain via the spinal cord is still not completely understood. Because the location in the spinal cord area in which pain signals from the heart are received is located near areas in which similar pain signals for the chest wall and arms are received, it is believed that “spillover” in these spinal cord areas is responsible for the perception of the cardiac discomfort in the arms, chest, and occasionally the back. Patients usually are not aware of injuries to internal organs unless the affected organ swells, causing pressure on nerve endings, and these nerve fibers then transmit pain impulses to the brain. This neurological pathway is true of the liver, lung, intestines, and heart. In the case of the heart, inflammation of its outer lining surface, the pericardium, causes sharp pain while breathing in and with certain body movements, similar in many ways to pleurisy, an inflammation of the outer lining of the lungs. Chest pain caused by inadequate blood supply to the heart muscle (a condition called ischemia) is usually different: Common phrases used by patients to describe the pressure sensation they feel are “vise-like” and “an elephant standing on my chest.” Sharp stabbing pains are not typical of angina or of the most severe form of ischemia (a heart attack, also known as myocardial infarction), though, as previously noted, this type of pain sometimes indicates inflammation of the lining of the heart (pericarditis). Interestingly, women with heart disease are more likely to experience atypical symptoms such as shortness of breath and fatigue for reasons that are not well understood.