12 Serious Diseases and Health Problems ( courtecy;- medicineNet.com

ARTICLE 12 Serious Diseases and Health Problems  ( courtecy;- medicineNet.com Symptoms that could indicate a serious health condition, and when you should see a doctor for symptoms of concern Causes of Chest Pain: Signs and Symptoms Symptoms of 12 serious diseases and health problems facts When is a cough "just" a cough, or a headache a symptom to be concerned about? Listed are signs and symptoms that could indicate a serious health condition, and you should see a doctor if you experience any symptoms of concern. Sometimes, a symptom in one part of the body may be a sign of a problem in another part of the body. Moreover, unrelated symptoms that might be minor on their own could be warning signs of a more serious medical disease or condition. Listen to your body, note all symptoms, and share them in detail with your doctor. Signs of a heart attack include pain, pressure, squeezing, or feeling of fullness in the center of the chest that lasts more than a few minutes; pain or discomfort in other areas of the upper body; shortness of breath; cold sweat; nausea; or lightheadedness. Signs of a stroke include facial drooping, arm weakness, difficulty with speech, rapidly developing dizziness or balance, sudden numbness or weakness, loss of vision, confusion, or severe headache. Symptoms of reproductive health problems include bleeding or spotting between periods; itching, burning, or irritation genital area; pain or discomfort during sex; heavy or painful menstrual bleeding; severe pelvic/abdominal pain; unusual vaginal discharge; feeling of fullness in the lower abdomen; and frequent urination or urinary urgency. Symptoms of breast problems include nipple discharge, unusual breast tenderness or pain, breast or nipple skin changes, or lump or thickening in or near breast or in the underarm area. Symptoms of lung problems include coughing up blood, shortness of breath, difficulty breathing, chronic cough, repeated bouts of bronchitis or pneumonia, and wheezing. Symptoms of stomach or digestive problems include rectal bleeding, blood in the stool or black stools, changes in bowel habits or not being able to control bowels, constipation, diarrhea, heartburn or acid reflux, or vomiting blood. Symptoms of bladder problems include difficult or painful urination, frequent urination, loss of bladder control, blood in urine, waking frequently at night to urinate or wetting the bed at night, or leaking urine. Symptoms of skin problems include changes in skin moles, frequent flushing and redness of face and neck, jaundice, skin lesions that don't go away or heal, new growths or moles on the skin, and thick, red skin with silvery patches. Symptoms of muscle or joint problems include persistent muscle pains and body aches that are persistent, for example, numbness or tingling; pain, tenderness, stiffness, swelling, inflammation, or redness in or around joints; and decreased range of motion or loss of function of any joints or muscles. Symptoms of emotional problems include anxiety, depression fatigue, feeling tense, flashbacks and nightmares, disinterest in regular activities, suicidal thoughts, hallucinations, or delusions. Symptoms of headache problems (not including everyday tension headaches) include headaches that come on suddenly, "the worst headache of your life," and headache associated with severe dizziness, nausea, vomiting, and inability to walk. Symptoms of eating or weight problems include extreme thirst, dehydration, excessive hunger, losing weight without trying, binging, vomiting, starvation, preoccupation with food and weight, distorted body image, compulsive exercise, abuse of laxatives or diet pills, and depression. Heart Attack Symptoms in Women Chest pain and pressure are the characteristic symptoms of a heart attack; however, women are somewhat more likely than men to experience heart attack that does not occur in this typical fashion. Instead, some women with heart attacks may experience more of the other symptoms, like lightheadedness, nausea, extreme fatigue, fainting, dizziness, or pressure in the upper back. Read more about heart attack symptoms in women » 15 Signs and Symptoms of a Heart Attack  Readers Comments 2  Share Your Story Heart attacks in real life often are not as dramatic as they appear to be in movies. Some early symptoms of a heart attack can happen a month or so before the heart attack. Before a heart attack, you may experience these symptoms: Unusual fatigue/low energy Trouble sleeping Problems breathing Indigestion Anxiety Back or abdominal pain During a heart attack, these symptoms may occur: Pain, uncomfortable pressure, squeezing, or feeling of fullness in the center of the chest that lasts more than a few minutes, or goes away and comes back Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach Shortness of breath, with or without chest discomfort Other symptoms are: Breaking out in a cold sweat Nausea and/or vomiting, Lightheadedness Women also experience chest pain or discomfort, but also are more likely than men to experience shortness of breath, nausea/vomiting, and back or jaw pain. If you have any of the above symptoms, go to an emergency room right away or call 911. 10 Signs and Symptoms of a Stroke  Readers Comments 1  Share Your Story Signs of a stroke happen suddenly and are different from signs of a heart attack. The American Stroke Association recommends remembering the mnemonic F.A.S.T. to spot a stroke and know when to call 9-1-1 for help: Face drooping Arm weakness Speech difficulty Time to call 9-1-1 Other signs and symptoms of stroke to watch for include: Sudden or rapidly developing problems with sight Sudden or rapidly developing problems with dizziness, balance, and coordination Sudden numbness or weakness in the face, arms, or legs Sudden confusion or trouble understanding Sudden inability to say the right word, incoherent speech, or slurred speech Severe headache with no known cause If you have any of the above symptoms, go to an emergency room right away or call 911. 5 Signs and Symptoms of Breast Disease A woman has a 1 in 8 chance of developing breast cancer in her lifetime. However, though many breast problems are not cancer-related, they do require prompt evaluation. Signs and symptoms of breast problems include: Nipple discharge (could be milky, yellowish, greenish, or brownish) Unusual breast tenderness or pain Breast or nipple skin changes, such as ridges, dimpling, pitting, swelling, redness, or scaling Lump or thickening in or near the breast or underarm area Inverted nipples If you experience any of these breast problem symptoms, see a health-care professional for evaluation. 7 Signs and Symptoms of Lung Disease  Share Your Story Lung cancer, chronic obstructive pulmonary disease (COPD), emphysema, asthma, and other diseases of the lungs can be serious and should be addressed. Symptoms of serious lung problems include: Coughing up blood Severe wheezing Difficulty breathing If you have any of the above symptoms, go to an emergency room right away or call 911. Other symptoms of lung problems include: Persistent, chronic cough that gets worse over time Repeated bouts of bronchitis or pneumonia Chronic mucus production (phlegm) Chronic chest pain, especially discomfort which gets worse when you inhale or cough Contact a health-care professional to discuss your symptoms. 7 Signs and Symptoms of Bladder Problems Bladder problems can be frustrating and embarrassing, and are not something you should simply "learn to live with," as they can be signs of a more serious condition. See a health-care professional if you experience any of the following symptoms of bladder problems: Difficult or painful urination Frequent urination (more than 8 times daily) Loss of bladder control Blood in the urine Feeling the urge to urinate when the bladder is empty Waking frequently at night to urinate or wetting the bed at night Leaking urine when you laugh, cough, sneeze, or exercise Urologists are doctors that specialize in the function and diseases of the bladder. 12 Signs and Symptoms of Mental Illness or Emotional Problems  Readers Comments 1  Share Your Story Note: These symptoms can have a physical cause and are usually treatable. Anxiety and constant worry Feeling depressed, empty, sad all the time, or worthless Extreme fatigue even when rested Extreme tension that can't be explained Flashbacks and nightmares about traumatic events No interest in getting out of bed or doing regular activities, including eating or having sex Thoughts about suicide and death Thoughts of killing others Seeing or hearing things that aren't there (hallucinations) Seeing things differently from what they are (delusions) "Baby blues" that haven't gone away two weeks after giving birth and seem to get worse over time Thoughts about harming yourself or your baby after giving birth If you feel suicidal or homicidal, seek medical treatment immediately. If you experience any other mental or emotional problems, you may be referred to a psychiatrist, a doctor who specializes in mental illness, and/or a psychologist, who is a counselor who can help you talk about your problems. 15 Symptoms of Female Reproductive Health Problems In women, there are numerous conditions that can affect the reproductive system, such as cancer, uterine fibroids, endometriosis, ovarian cysts, infertility, and sexually transmitted diseases (STDs) and more. Symptoms of female reproductive and hormonal health problems include: Bleeding or spotting between periods Itching, burning, or irritation (including bumps, blisters, or sores) of the vagina or genital area Pain or discomfort during sex Excessively heavy bleeding or severe pain with periods Severe pelvic/abdominal pain A change in vaginal discharge (amount, color or odor) Feeling of fullness in the lower abdomen Frequent urination or feeling of urgency to urinate Lower back pain Pelvic Pain Known reproductive problems such as infertility, past miscarriages or early labor Excessive hair growth on the face, chest, stomach, thumbs, or toes Baldness or thinning hair Acne, oily skin, or dandruff Patches of thickened dark brown or black skin If you experience any of the above symptoms, see your doctor to determine the cause. 9 Signs and Symptoms of Stomach and Digestive Diseases The digestive system runs all the way from your mouth, through the esophagus, stomach, small intestine, large intestine and rectum, to the anus. It also includes the liver, pancreas, and gallbladder. Problems with any of these organs can affect your daily life. Symptoms of stomach or digestive problems include: Bleeding from the rectum (rectal bleeding) Blood or mucus in the stool (including diarrhea) or black stools Change in bowel habits or not being able to control your bowels Constipation and/or diarrhea Heartburn or acid reflux (a burning feeling in the throat or mouth) Pain or feeling of fullness in the stomach Unusual abdominal swelling, bloating, or general discomfort Chronic vomiting Vomiting blood For any severe symptoms, go to an emergency room or call 911. For mild or moderate symptoms, call a health-care professional who may recommend you see a gastroenterologist, a specialist in the digestive system who can help diagnose, manage, or treat your condition. Subscribe to MedicineNet's Heart Health Newsletter By clicking "Submit," I agree to the MedicineNet Terms and Conditions and Privacy Policy. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time. 8 Signs and Symptoms of Skin Cancer Skin cancer is the most common form of cancer in the U.S., and one type of skin cancer - melanoma - is particularly deadly. It's important to know what your skin normally looks like, and notice any signs and symptoms of skin problems including: Changes in skin moles, such as changes in shape, color or size Frequent flushing and redness of face and neck Jaundice (skin and whites of eyes turn yellow) Painful, crusty, scaling, or oozing skin lesions that don't go away or heal Sensitivity to the sun Small lump on skin that is smooth, shiny, and waxy (red or reddish-brown) New growths or new moles on the skin Thick, red skin with silvery patches See a dermatologist (a skin specialist) to evaluate any skin problems you are experiencing. 8 Signs and Symptoms of Muscle or Joint Disease Many different diseases and conditions that can affect the muscles and joints. See a doctor if you experience any of the following symptoms: Muscle pains and body aches that are persistent, or that come and go often Numbness, tingling (pins and needles sensation) or discomfort in the hands, feet, or limbs Pain, tenderness, stiffness, swelling, inflammation, or redness in or around joints Decreased range of motion of the joints Loss of function of any muscles or joints Muscle weakness Decreased grip strength Excessive fatigue Your general practitioner may refer you to a specialist if you are experiencing muscle or joint problems. You may be referred to a rheumatologist (specialist in disorders of the joints and autoimmune disorders), an orthopedic physician (specialist in the bones and muscles) or to a physiatrist (specialist in physical medicine and rehabilitation). From  12 Signs and Symptoms of Headache Disorders Note: This does not include everyday tension headaches. We all have headaches from time to time, but if headaches are particularly severe or frequent, you may have migraines or another serious type of headache disorder. Symptoms of serious headache disorders include: Headache that comes on suddenly "The worst headache of your life" Headache associated with severe dizziness/fainting, vomiting, and inability to walk Headache associated with confusion, seizure, difficulty speaking, or weakness/numbness in the limbs Severe headache associated with neck stiffness and fever If you have any of the above symptoms, go to an emergency room right away or call 911. Other symptoms of headache problems include: Headaches between the eyes Headaches that last longer than a couple of days Seeing flashing lights or zigzag lines with temporary vision loss before a headache starts Spreading pain in the face that starts in one eye Severe pain on one or both sides of head with nausea or vision problems Extremely severe headache with pain around the eye with tearing and redness, runny nose, and eyelid droop. Tell your doctor if you experience any of these symptoms of headache disorders. You may be referred to a headache specialist, usually a neurologist. 14 Signs and Symptoms of Eating Disorders and Weight Problems Most of us gain or lose some weight from time to time, and this is usually normal. For some people who have eating disorders such as bulimia or anorexia nervosa, a preoccupation with weight becomes a serious medical issue. Signs and symptoms of eating or weight problems include: Extreme thirst, dehydration, or hunger Losing weight without trying or abnormal weight loss Desire to binge on food excessively Desire to vomit on purpose Desire to starve (not eat at all) A preoccupation with food and weight Distorted body image Excessive fear of gaining weight Refusing to eat or eating tiny portions or eating alone Compulsive exercise Sensitivity to cold Menstruation ceases Abuse of laxatives, diuretics, or diet pills Depression Eating disorders are very serious and can lead to severe medical complications, and even death. Tell a health-care professional about your issues with food and weight, or get help if you have a loved one who suffers from these issues. In addition to a doctor who specializes in treating eating disorders, you may need to see a dietician, a psychiatrist, and an eating disorder therapist. SYMPTOMS OF 12 SERIOUS DISEASES AND HEALTH PROBLEMS CENTER Medically Reviewed on 3/23/2018 References CONTINUE SCROLLING FOR RELATED ARTICLE Chest Pain Chest pain definition and facts  Readers Comments 7  Share Your Story Chest pain is one of the most common symptoms that bring an individual to the emergency department. Seeking immediate care may be lifesaving, and considerable public education has been undertaken to get patients to seek medical care when chest pain strikes. You may be worried that you are having a heart attack, but there are many other causes of pain in the chest that the doctor will consider. Some diagnoses of chest pain are lifethreatening, while others are less dangerous. Deciding the cause of chest pain is sometimes very difficult and may require blood tests, X-rays, CT scans and other tests to sort out the diagnosis. Often though, a careful history taken by the doctor may be all that is needed.There are many causes of chest pain, and while many are not serious, it may be difficult to distinguish a heart attack, pulmonary embolus, or aortic dissection, from another diagnosis that is not life-threatening, like heartburn. For that reason, individuals are routinely advised to seek medical evaluation for most types of chest pain. While each cause of chest pain has classic symptoms and signs, there are enough variations in symptoms that it may take specific testing to reach a diagnosis. These tests will depend on the your current health and the healthcare professionals index of suspicion as to what the diagnosis might be. Treatment for chest pain depends upon the cause. It is best to be safe. Always seek medical care if you are having chest pain. What are the sources of chest pain? The following anatomic locations can all be potential sources of chest pain: the chest wall including the ribs, the muscles, and the skin; the back including the spine, the nerves, and the back muscles; the lung, the pleura (the lining of the lung), or the trachea; the heart including the pericardium (the sac that surrounds the heart); the aorta; the esophagus; the diaphragm, the flat muscle that separates the chest and abdominal cavities; and referred pain from the abdominal cavity including organs like the stomach, gallbladder, and pancreas, as well as irritation from the underside of the diaphragm due to infection, bleeding or other types of fluid. There may be classic presentations of signs and symptoms for many diseases but they can also present atypically and there may also be significant overlap among the symptoms of each condition. Age, gender, and race can affect presentation and the health care professional must consider many variables before reaching a diagnosis. Chest Pain Symptoms Chest pain can be associated with symptoms such as dizziness, lightheadedness, shortness of breath, or stabbing or burning sensations. Read more about chest pain symptoms and signs » What are the causes of chest pain?  Readers Comments 48  Share Your Story Pain can be caused by almost every structure in the chest. Different organs can produce different types of pain, unfortunately, the pain is not specific to each cause. Each of the following causes of chest pain will be discussed. Broken or bruised ribs Pleuritis or pleurisy Pneumothorax Shingles Pneumonia Pulmonary embolus Angina Heart attack (myocardial infarction) Pericarditis The aorta and aortic dissection The esophagus and reflux esophagitis Referred abdominal pain How is chest pain diagnosed? The key to diagnosis remains the patient history. Learning about the nature of the pain will give the health care professional direction as to what are reasonable diagnoses to consider, and what are reasonable to exclude. Understanding the quality and quantity of the pain, its associated symptoms and the patient's risk factors for specific disease, can help the doctor assess the probability of each potential cause and make decisions about what diagnoses should be considered and which ones can be discarded. Differential diagnosis is a thought process that healthcare professionals use to consider and then eliminate potential causes of an illness. As more information is gathered, either from history, physical examination, or testing, the potential diagnosis list is narrowed until the final answer is achieved. Moreover, the patient's response to therapeutic interventions can expand or narrow the differential diagnosis list. In patients with chest pain, many possible conditions may be present, and the health care professional will want to first consider those that are life threatening. Using laboratory and X-ray tests may not be necessary to exclude potentially lethal diseases like heart attack, pulmonary embolus, or aortic dissection when clinical skills and judgment are employed. The patient may be asked a variety of questions to help the health care professional understand the quality and quantity of the pain. Patients use different words to describe pain, and it is important that the health care professional get an accurate impression of the situation. The questions may also be asked in different ways. Questions the doctor may ask about chest pain When did the pain start? What is the quality of the pain? How long does the pain last? Does the pain come and go? What makes the pain better? What makes the pain worse? Does the pain radiate somewhere (move to another area of the body)? Has there been any preceding illness? Has there been any trauma? Have there been similar episodes of pain in the past? Is the pain different from that of a previous condition that has been experienced, or is it similar? Questions about the associated symptoms Is there shortness of breath? Fever or chills? Cough? Nausea or vomiting? Sweating? Questions about risk factors for disease Risk factors for atherosclerotic heart disease (also known as coronary artery disease) Smoking High blood pressure High cholesterol Diabetes Family history Risk factors for pulmonary embolus (blood clot to the lung) Prolonged inactivity such as bed rest, long car or airplane trips Recent surgery Fractures Birth control pill use (particularly if the patient smokes cigarettes) Cancer Risk factors for aortic dissection High blood pressure Marfan syndrome Ehlers-Danlos syndrome Polycystic kidney disease Cocaine use Pregnancy Physical examination helps refine the differential diagnosis. While chest pain may be the initial complaint, often the whole body needs to be examined. Example components of the physical exam may include: Vital signs Blood pressure (BP), pulse rate (PR), respiratory rate (RR), temperature, and Oxygen saturation (O2 sat) which measures the amount of oxygen being carried by red blood cells in the bloodstream. Head and neck Looking for neck vein distension or bulging Listening over the carotid arteries for bruits (abnormal sounds) or murmurs that begin in the heart and radiate to the neck Chest wall Palpate for rib or muscle tenderness Look for rashes including the rash of shingles (zoster) Lungs Listen for abnormal lung sounds like crackle or wheeze or decreased air entry with inspiration Listen for rubs (a friction sound made by two rough surfaces rubbing against each other) that may be heard in pleurisy Heart Listen for abnormal heart sounds, murmurs or rubs (which may be heard with inflammation of the heart lining, called pericarditis) Listen for muffled or indistinct heart tones that can be associated with excess fluid in the pericardium, the sac that surrounds the heart Abdomen Palpate for tenderness or masses Listen for bruits over the aorta Extremities Feel for pulses What is the philosophy of the approach to chest pain diagnosis? While there are many causes of chest pain, the health care professional will keep those that are potentially lethal front and center in their evaluation of a patient presenting with chest pain. The big three -- heart attack (myocardial infarction), pulmonary embolus, and aortic dissection -- should be considered briefly with every patient, although most of the time their presence can be discarded based upon clinical judgment. History and physical examination are key in deciding which path to follow in the diagnosis of chest pain. For somebody who fell and hurt his or her ribs, that path is well marked. For an elderly person who presents with vague discomfort and risk factors for an illness, significant testing may need to be done to prove that a given diagnosis is not correct. The concept of ruling out a diagnosis is difficult for some patients to understand. Instead of proving what is happening, the health care professional is sometimes charged with proving that a life-threatening diagnosis is not present. "Proving what isn't" takes time and technology. A combination of blood tests and imaging studies may take hours to confirm or discard a potential diagnosis. These tests often are done emergently, and treatment may be started even without a firm diagnosis. For example, if a patient presents with chest pain that the health care professional believes may be angina (pain caused because of narrowing of coronary arteries that supply blood to the heart muscle), then the initial medications to protect the heart will be started at the same time the diagnostic tests are done. Because some heart tests will take hours to complete, the philosophy for this approach is that heart muscle should not be placed at risk while waiting for a diagnosis. If the heart proves to be normal, then the medications are stopped, and the patient can be reassured that heart disease has been ruled out. Other diagnoses are also considered at the same time the heart tests are being performed, but ruling out one diagnosis does not confirm another. F What is the treatment for chest pain?   Treatment for chest pain depends upon the cause. Many times, situations require that the evaluation, diagnosis, and treatment occur at the same time, but when there is opportunity, the sequence of history, physical examination, testing, diagnosis, and treatment should be followed. A synopsis of common chest pain presentations and treatments follows. Broken or bruised ribs  Readers Comments 2  Share Your Story Bruised or broken ribs are common injuries. Symptoms of broken or bruised ribs include: tenderness over the site of injury; a broken rib may be palpated (the health care professional can feel the rib fracture move when pressed); the pain tends to be pleuritic (it hurts to take a deep breath and can be associated with shortness of breath); and because the surrounding muscles go into spasm, there is pain with any movement of the trunk. The healthcare professional will want to listen to the chest to make certain that there is no associated lung damage. Sometimes, subcutaneous emphysema can be felt, a sensation of feeling rice krispies when air leaks into the skin. A chest X-ray may be done to look for a pneumothorax (collapsed lung) or pulmonary contusion (a bruised lung). Special X-rays looking for rib fracture are not needed since the presence or absence of a fracture will not alter the treatment plan or recuperation time. Special attention will be given to the upper abdomen since the ribs protect the spleen and liver, to make certain there are no associated injuries. The major complication of rib injuries is pneumonia. The lungs work like bellows. Normally, when one takes a breath, the ribs swing out and the diaphragm moves down, sucking air into the lungs. Because it hurts to take a deep breath, this mechanism is altered, and the lung underlying the injury may not fully expand because the patient cannot tolerate the pain. The result is stagnant air and lung tissue that does not fully expand, causing a potential breeding ground for a lung infection (pneumonia). Rib injury treatment may include: Pain control with anti-inflammatory medications like ibuprofen and narcotic pain medications to allow deep breaths to occur. Application of ice to the affected area and to periodically deep take breaths. An incentive spirometer may be provided to help visualize the amount of breath to take. Ribs are no longer wrapped or taped to help with comfort. Wrapping broken ribs decreases the ability of the lung underneath the injured area to fully expand, which increases the risk of developing pneumonia. Whether broken or bruised, rib injuries take 3 to 6 weeks to heal. Costochondritis On occasion, the joints and cartilage where ribs attach to the sternum (breastbone) may become inflamed. The pain tends to occur with a deep breath, and there is tenderness that can be felt when the sides of the sternum are palpated or touched. If there is swelling and inflammation associated with the tenderness, it is known as Tietze's syndrome. The most frequent cause for costochondritis is idiopathic or unknown, meaning there is no explanation for the pain. Other causes include trauma to the area, infection (often viral), and fibromyalgia. Though painful, the symptoms resolve with symptomatic care, including ice and/or warm compresses and anti-inflammatory medications (for example, ibuprofen). As with other chest wall pain, recovery may take weeks. Taking deep breaths to prevent the risk of pneumonia is very important. For more, please read the Costochondritis and Tietze Syndrome article. Pleuritis or pleurisy The lung slides along the chest wall when a deep breath is taken. Both surfaces have a thin lining called the pleura to allow this sliding to occur. On occasion, viral infections can cause the pleura to become inflamed, and then instead of sliding smoothly, the two linings scrape against each other, causing pain. This type of chest pain hurts with a deep breath, and feels like the pain of pleurisy. Viral infections are a common cause of pleurisy, although there are many other infectious causes including tuberculosis. Other diseases that can inflame the pleura include: collagen vascular diseases like sarcoidosis and systemic lupus erythematosus, cancer, kidney failure, rheumatoid arthritis, complications of radiation therapy, complications of chemotherapy, and complications of surgery. The physical exam may be relatively unremarkable, but a friction rub may be heard over the site of pleural inflammation. If a significant amount of fluid leaks from the inflammation, the space between the lung and the chest wall (the pleural space) can fill with fluid, known as an effusion. When listening with a stethoscope, there may be decreased air entry in the lung. As well, percussion, in which the health care professional taps on the chest wall like a drum, may reveal dullness of one side compared to the other. Often a chest X-ray is done to assess the lung tissue and the presence or absence of fluid in the pleural cavity. Pleurisy is usually treated with an anti-inflammatory medication. This will often treat an effusion as well. If the effusion is large and is causing shortness of breath, thoracentesis (thora=chest + centesis=withdrawing fluid) may be done. For thoracentesis, a needle is placed in the pleural space and the fluid withdrawn. Aside from making the patient feel better, the fluid may be sent for laboratory analysis to help with diagnosis. For more, please read the Pleurisy article. Pneumothorax The lung is held against the chest wall by negative pressure in the pleura. If this seal is broken, the lung can shrink down, or collapse (known as pneumothorax). This may be associated with a rib injury or it may occur spontaneously. However, commonly seen in those who are tall and thin, other risk factors for a collapsed lung include emphysema or asthma. Small blebs or weak spots in the lung can break and cause the air leak that breaks the negative pressure seal. The common presentation is the acute onset of sharp chest pain associated with shortness of breath, with no preceding illness or warning. Physical examination reveals decreased air entry on the affected side. Percussion may show increased resonance with tapping. Chest X-ray confirms the diagnosis. Treatment is dependent upon what percentage of the lung is collapsed. If it is a small amount and vital signs are stable with a normal O2 sat, the pneumothorax may be allowed to expand on its own with close monitoring. If there is a larger collapse, a chest tube may have to be placed into the pleural space through the chest wall to suck the air out and re-establish the negative pressure. On occasion, thoracoscopy (thoraco=chest +scopy=see with a camera) may be considered to identify the bleb and to staple it shut. For more, please read the Pneumothorax article. Tension pneumothorax is a relatively rare life-threatening event often associated with trauma. Instead of a simple collapse of the lung, a scenario can exist in which the damaged lung tissue acts as a one-way valve allowing air to enter into the pleural space but not allowing it to escape. The pneumothorax size increases with each breath and can prevent blood from returning to the heart and allowing the heart to pump it back to the body. If not corrected quickly with placement of a chest tube, it can be fatal. Shingles Sihingles is caused by the varicella zoster virus, the same one that causes chickenpox. Once the virus enters the body, it hibernates in the nerve roots of the spinal column, only to emerge sometime in the future. The rash is diagnostic as it follows the nerve root as it leaves the back, and circles to the front of the chest, but never crosses the midline. Once the rash appears, the diagnosis is relatively easy for the health care professional. Unfortunately, the pain of shingles may begin a few days before the rash emerges and can be confusing to both patient and health care professional, since the pain and burning may seem out of proportion to the findings on physical examination. The treatment for shingles includes antiviral medications like acyclovir (Zovirax) along with pain control medication. The pain from the inflamed nerve can be can be quite severe. Some patients may develop postherpetic neuralgia, or chronic pain from the inflamed nerve, which may persist long after the infection has cleared. A variety of pain control strategies are available from medication to pain stimulators to surgery. For more, please read the Shingles article. Pneumonia An infection of the lung is called pneumonia, in which inflammation can cause fluid buildup within a segment of the lung tissue, decreasing its ability to transfer oxygen from air to the bloodstream. Pneumonia presents with the typical symptoms of an infection: fever, chills, and malaise. There may also be: cough, shortness of breath, and sputum production (coughing up mucus). The chest pain is pleuritic, hurting when taking a deep breath. The classic presentation of a lung infection caused by the bacteria Streptococcal pneumoniae or pneumococcus, one of the most common causes of pneumonia, is acute onset of shaking chills, fever, and a cough that produces rusty brown sputum. Physical examination may find the patient to have abnormal vital signs consistent with an infection. The pulse rate and respiratory rate may be elevated. A fever may be present. Listening to the chest may reveal decreased air entry in the area of the infection associated with crackles and occasionally wheezing because of inflammation and narrowing of the bronchial tubes. A chest X-ray helps make the diagnosis, though the X-ray image sometimes lags behind the clinical findings by a day or two. Blood tests may be used to assess the severity of illness and may include a white blood cell count (markedly elevated or abnormally low counts may indicate more severe illness). Oxygen saturation measured with a probe attached to the finger is a way of assessing oxygenation of the blood and is routinely performed on patients with chest pain or shortness of breath. An arterial blood gas can exactly measure the amount of oxygen and carbon dioxide in the bloodstream to help determine the level of lung function. Pneumonia may be caused by viruses or bacteria. The latter are treated with antibiotics, either by mouth or in the hospital by intravenous infusion. The general health and past medical history of the patient may guide the decision as to whether inpatient or outpatient therapy is most appropriate. For more, please read the Pneumonia article. Pulmonary embolism A blood clot to the lung can be fatal and is one of the diagnoses that should always be considered when a patient presents with chest pain. The classic signs and symptoms of a blood clot in the lung are pain when taking a deep breath, shortness of breath, and coughing up blood (hemoptysis); but more commonly, patients can have more subtle symptoms, and the diagnosis may be easily missed. Risk factors for pulmonary embolus include: prolonged inactivity like a long trip in a car or airplane, recent surgery or fracture, birth control pills (especially associated with smoking), cancer, and pregnancy. Thrombophilia (thrombo=clot + philia= attraction) comprises a host of blood clotting disorders that place patients at risk for pulmonary embolus. The pulmonary embolus begins in veins elsewhere in the body, usually the legs, though it can occur in the pelvis, arms, or the major veins in the abdomen. When a thrombus or blood clot forms, it has the potential to break free (now called an embolus) and float downstream, returning to the heart. The embolus can continue its journey through the heart and enter into the pulmonary circulation system, eventually becoming lodged in the branches of the pulmonary artery and cutting off blood supply to part of the lung. This decreased blood flow doesn't allow enough blood to pick up oxygen in the lung, and the patient can become markedly short of breath. As mentioned above, the common complaints include: pleuritic chest pain from the inflamed lung, bloody sputum, and shortness of breath. The patient can also have anxiety and sweat profusely. Depending upon the size of the clot, the initial presentation may be fainting (syncope) or shock in which the patient collapses, with decreased blood pressure and altered mental function. Depending on the severity of the embolus and the amount of lung tissue at risk, the patient may present critically ill (in extremis) with markedly abnormal vital signs, or may appear rather normal. Physical examination may not be helpful, and the diagnostic studies are done upon clinical suspicion based on history and risk factors. The diagnosis may be made directly with imaging of the lungs or indirectly by finding a clot elsewhere in the body. The strategy used to make a diagnosis will depend upon each individual patient's situation, but there are some general tools available. D-Dimer is a blood test that can measure breakdown products of blood clots in the body but cannot differentiate a pulmonary embolus from a healing scar from surgery, or a bruise from falling. If this test is negative, then a pulmonary embolus can usually be excluded if the patient is in a low risk category to form clots. Cancer and pregnancy are two other situations in which the D-Dimer test is often positive even without blood clots present. Lungs can be imaged with a ventilation-perfusion scan or a CT scan to look for a clot. Each test has its benefits and limitations, and use of these tests is dependent upon the clinical situation. If there are technical issues so that the lungs cannot be imaged, an ultrasound of the legs may be performed to look for a thrombus; the concept is that if the symptoms are present of a pulmonary embolus and a clot is found in the leg, then the diagnosis can be inferred. However, if the complete clot has broken free, the leg ultrasound may be normal even when a pulmonary embolism is present. Sometimes direct angiography of the pulmonary arteries may be performed. Catheters are placed into the pulmonary artery, and a dye is injected. This test must be performed by a specially trained radiologist or cardiologist. The treatment for pulmonary embolus is anticoagulation using either heparin or enoxaparin (Lovenox) initially, and then transitioning to warfarin (Coumadin) for long-term treatment. The usual treatment course for anticoagulation for a pulmonary embolus is 3 to 6 months. The lungs and heart can stop working if there is a large enough clot load. Thrombolytic, or clot busting, therapy may be considered in addition to the basics of oxygen, intravenous fluids, and medicines to support blood pressure. In rare and extreme cases, lytic agents may be directly injected into the area of clot. Pulmonary embolus should always be considered a life-threatening illness. For additional information, please read the Pulmonary Embolism article. The heart Angina and heart attack (myocardial infarction)  Readers Comments 1  Share Your Story The worry for patients and health care professionals is that any chest pain may originate from the heart. Angina is the term given to pain that occurs because the coronary arteries (blood vessels to the heart muscle) narrow and decrease the amount of oxygen that can be delivered to the heart itself. This can cause the classic symptoms of chest pressure or tightness with radiation to the arm or jaw associated with shortness of breath and sweating. Unfortunately, many people don't present with classic symptoms, and the pain may be difficult to describe -- or in some people may not even be present. Instead of angina or typical chest pressure, their anginal equivalent (symptom they get instead of chest pain) may be indigestion, shortness of breath, weakness, dizzyness, and malaise. Women and the elderly are at higher risk for having an atypical presentation of heart pain. The narrowing of blood vessels or atherosclerosis is due to plaque buildup. Plaque is a soft amalgam of cholesterol and calcium that forms along the inside lining of the blood vessel and gradually decreases the diameter of the blood vessel and restricts the flow of blood. If the plaque ruptures, it can cause a blood clot to form and completely block the vessel. When a coronary artery completely occludes (becomes blocked), the muscle it supplies blood to is at risk of dying. This is a heart attack or myocardial infarction. In most circumstances, this pain is more intense than routine angina, but again, there are many variations in signs and symptoms. The diagnosis of angina is a clinical one. After the health care professional takes a careful history and assesses the potential risk factors, the diagnosis is either reasonably pursued or else it is considered not to be present. If angina is the potential diagnosis, further evaluation may include electrocardiograms (EKG or ECG) and blood tests. Cardiac enzymes can be measured in the bloodstream when heart muscle is irritated or damaged. Common enzymes to measure include troponin, CPK, and myoglobin. Unfortunately, it takes time for these chemicals to be released into the bloodstream and turn a blood test positive. Interpretation of the test results may require that blood be taken more than once over a period of observation to confirm that they are normal. If these chemicals are not present, it may be reasonable to perform imaging studies of the heart in a variety of ways depending on the patient's past history: Stress tests in which the electrocardiogram is monitored during exercise. This can be done by actual exercise or by chemically stimulating the heart with injected medications. The stress test may be performed in association with an echocardiogram. Echocardiography (ultrasound evaluation) of heart structure and function Computerized cardiac angiography in which the CT scan can image the heart's blood vessels Coronary catheterization, in which tubes are floated through a major blood vessel into the heart and dye is used to directly image heart blood vessels looking for blockage The purpose of making the diagnosis of angina is to restore normal blood supply to heart muscle before a heart attack occurs and permanent muscle damage results. Aside from minimizing risk factors by controlling blood pressure, cholesterol, and diabetes, and stopping smoking, medications can be used to make the heart beat more efficiently (for example, beta blockers), to dilate blood vessels (for example, nitroglycerin) and to make blood less likely to clot (aspirin). An acute heart attack (myocardial infarction) is a true emergency, since complete blockage of blood supply will cause part of the heart muscle to die and be replaced by scar tissue. This lessens the ability of the heart to pump blood to meet the body's needs. As well, injured heart muscle is irritable and can cause electrical disturbances like ventricular fibrillation, a condition in which the heart jiggles like Jell-O and cannot beat in a coordinated fashion. This is the cause of sudden death in heart attack. The cause of an acute heart attack is the rupture of a cholesterol plaque in a coronary artery. This causes a blood clot to form and occlude the artery. The treatment for heart attack is emergent restoration of blood supply. Two options include use of a drug like TPA or TNK to dissolve the blood clot (thrombolytic therapy) or emergency heart catheterization and using a balloon to open up the blocked area (angioplasty) and keeping it open with a mesh cage called a stent. Emergent angioplasty is preferred if the patient lives close to a hospital with that capability but many people do not. Staged treated with initial thrombolytic therapy followed by angioplasty is also reasonable. Coronary artery bypass surgery is considered when there is diffuse artery disease that is not amenable to angioplasty and stenting. For more, please read the Angina and Heart Attack articles. Pericarditis The heart is contained in a sac called the pericardium. Just like in pleurisy, this sac can become inflamed and cause pain. As opposed to angina, this pain tends to be sharp and is due to the inflamed sac rubbing against the outer layers of the heart. The most common cause of pericarditis either is a viral illness or is unknown (idiopathic). Inflammatory diseases of the body (rheumatoid arthritis, systemic lupus erythematosus), kidney failure, and cancer are other conditions that can cause pericarditis. Trauma, especially from steering wheel injuries in motor vehicle accidents can also cause pericarditis. The pain with pericarditis is intense, sharp, tends to be worse when lying down, and is relieved by leaning forward. Because the pain can be so severe, radiate to the arm or neck, and cause some shortness of breath, it is sometimes mistaken for angina, pulmonary embolus, or aortic dissection. Associated symptoms may include fever and malaise depending upon the cause. History is helpful in making the diagnosis, looking for a recent viral illness, and asking about past medical history. Physical examination may reveal a friction rub when listening to the heart sounds. The electrocardiogram may show changes consistent with pericarditis, but on occasion, the EKG may mimic an acute heart attack. Echocardiogram is helpful if there is fluid in the pericardial sac associated with the inflammation. An anti-inflammatory medication like ibuprofen is the treatment for pericarditis. Addressing the underlying cause will also direct therapy. Cardiac tamponade is a complication of pericarditis. Pressure from excess fluid built up in the pericardial sac is so great that it prevents blood from returning to the heart. The diagnosis is made clinically with the triad of (Beck's triad): low blood pressure, distention of neck veins, and muffled heart tones. Treatment is placing a needle into the pericardium to withdraw fluid and/or surgery to open a window in the pericardium to prevent future fluid buildup. For more, please read the Pericarditis article. Aorta and aortic dissection The aorta is the large blood vessel that exits the heart and delivers blood to the body. It is composed of layers of muscle that need to be strong enough to withstand the pressure generated by the beating heart. In some people, a tear can occur in one of the layers of the aortic wall, and blood can track between the wall muscles. This is called an aortic dissection, and is potentially life threatening. The type of dissection and treatment is dependent upon where in the aorta the dissection occurs. Type A dissections are located in the ascending aorta, which runs from the heart to the aortic arch where blood vessels that supply the brain and arms exit. Type B dissections are located in the descending aorta that runs through the chest and down into the abdomen. The majority of aortic dissections occur as a long-term consequence of poorly controlled high blood pressure. Other associated conditions include: Marfan's syndrome, trauma, pregnancy, and a late post-operative complication of open heart surgery. The pain from aortic dissection occurs suddenly and often is described as intense, stabbing, or ripping. It may be constant, or the pain may be pleuritic (worse with a deep breath). Often it radiates to the back. The pain of dissection is often confused with the pain of heart attack, esophagitis, or pericarditis. Diagnosis is based upon history, review of the risk factors, physical examination, and clinical suspicion. Physical examination may reveal loss or delay of pulses in the wrist or leg when comparing one side to the other. A new heart murmur may be detected if the dissection involves the aortic valve that connects the aorta with the heart. If blood vessels exiting the aorta are involved in the area of dissection, the organs that they supply may be at risk. Stroke and paralysis can be seen in dissection. Blood supply can be lost to kidneys and bowel and/or to arms and legs. The diagnosis of aortic dissection is confirmed by imaging, most commonly by CT angiography of the aorta. Echocardiography or ultrasound may also be used to image the aorta. Type A dissections of the ascending aorta are treated by surgery in which the damaged piece of aorta is removed and replaced with an artificial graft. Sometimes the aortic valve needs to be repaired or replaced if it is damaged. Type B dissections are initially treated by medications to control blood pressure and maintain it in a normal range. Beta blockers and calcium channel blocker medications are commonly used. If medical therapy fails, surgery may be necessary. If the dissection tears completely through all three layers of the aortic wall, then the aorta ruptures. This is a catastrophe, and more than 50% of affected patients die before reaching a hospital. The overall mortality of aortic rupture is greater than 80%. Esophagus and reflux esophagitis The esophagus is a muscular tube that carries food from the mouth to the stomach. The lower esophageal sphincter (LES) is a specialized band of muscle at the lower end of the esophagus that functions as a valve to keep stomach contents from spilling back into the esophagus. Should that valve fail, stomach contents, including acidic digestive juices, can reflux back and irritate the lining of the esophagus. While the stomach has a protective barrier lining to protect it from normal digestive juices, this protection is missing in the esophagus. Reflux esophagitis (also referred to as GERD, gastroesophageal reflux disease) can present with burning chest and upper abdominal pain that radiates to the throat and may be associated with a sour taste in the back of the throat called water brash. It may present after meals or at bedtime when the patient lies flat. There can be significant spasm of the esophageal muscles, and the pain can be intense. The pain of reflux esophagitis can be mistaken for angina, and vice versa. The physical examination is usually not helpful, and a clinical diagnosis is often made without further testing. Endoscopy may be performed to look at the lining of the esophagus and stomach. When symptoms are long-standing, they may be associated with, or cause, precancerous changes in the cells lining the lower esophagus. Manometry can be done to measure pressure changes in the esophagus and stomach to decide whether the LES is working appropriately. Barium swallow or gastrograph with fluoroscopy is a type of X-ray where the swallowing patterns of the esophagus can be evaluated. Treatment for reflux esophagitis includes: Dietary and lifestyle changes to limit the amount of acid that can backsplash from the stomach into the esophagus. Elevating the head of the bed allows gravity to keep acid from refluxing. Smaller meal sizes can limit stomach distention. Caffeine, alcohol, anti-inflammatory medications, and smoking are irritants to the lining of the stomach and esophagus and should be avoided. Acid blockers like omeprazole (Prilosec) or lansoprazole (Prevacid) can decrease the amount of stomach acid that is produced, and antacids like Maalox or Mylanta can help bind excess acid. The complications of acid reflux depend upon its severity and its duration. Chronic reflux can cause changes in the lining of the esophagus (Barrett's esophagus) which may lead to cancer. Reflux may also bring acid contents into the back of the mouth into the larynx (voice box) and cause hoarseness or recurrent cough. Aspiration pneumonia can be caused by acid and food particles inhaled into the lung. For more, please read the GERD article. Referred abdominal pain Conditions in the abdomen can present as pain referred to the chest, especially if there is inflammation along the diaphragm. Inflammation of the stomach, spleen, liver, or gallbladder can initially present with nonspecific pain complaints that may be associated with vague chest discomfort. Physical examination and time to allow the disease process to express itself often allow the appropriate diagnosis to be made. It is also the reason that the whole body is examined, even if the initial complaint is chest pain. Similarly, conditions in the chest may initially present as abdominal pain. Myocardial infarction of the inferior or lower portion of the heart can present as indigestion. Pneumonia can present as upper abdominal pain, especially if the lung inflammation is next to the diaphragm. Aortic dissection can present with chest pain, abdominal pain, or both, depending upon where the dissection occurs. Causes of Chest Pain: Signs and Symptoms What Is Chest Pain? Chest pain is discomfort or pain anywhere from a person's neck to the upper part of the abdomen. The discomfort or pain may be described as: Tightness Squeezing Crushing Tearing (or ripping) Stabbing Burning Aching Sharp Dull Palpitations (uneasiness or discomfort in chest because of a rapid heartbeat) Constant Intermittent What Causes Chest Pain? Chest pain may be caused by many different problems; although many people think chest pain is due only to problems with the heart, this is not true. Chest pain may arise as a result of problems with any of the structures located between the neck and the upper part of the abdomen. For example, the following is a list of tissues and organs that when disease is present may result in chest pain: Heart Lungs Chest muscles Bones (ribs, sternum, and clavicles for example) Esophagus Nerves Stomach Pancreas Gastrointestinal tract Skin Some causes of chest pain are medical emergencies (most heart problems, for example) and need to be evaluated immediately by medical caregivers. If you have chest pain and are unsure of the cause, seek medical attention immediately to have medical personnel evaluate you for the cause of your chest pain. Heart-Related (Cardiac) Causes of Chest Pain Heart problems are a common cause of chest pain. Coronary artery disease may result in a reduced blood flow to the heart tissue. The sharp pain it can cause is termed angina. This pain may spread to the left arm, both arms, shoulders, upper back, and even cause pain in the jaw. It may also cause pain in the back of the chest. Exercising, working hard, going up a flight of stairs or even emotional stress can trigger this chest pain. Another common cause of heart-related pain is a myocardial infarction or “heart attack.” This is due to a significant reduction or complete blockage of blood flow to an area of the heart muscle. Myocardial infarction often causes crushing or squeezing pain and/or tightness in the chest; this heart problem is a medical emergency. Other conditions may also cause heart muscle problems. In general, anything that causes the heart muscle to become inflamed (a viral infection of heart tissue, for example) can result in myocarditis (damage to the heart muscle due to inflammation). This can result in discomfort or palpitations in the chest along with shortness of breath. Abnormal heartbeats (arrhythmias) may result in regular or irregular heartbeats that can be too fast or slow. Fast heartbeats may result in palpitation symptoms, while slow heartbeats may result in weakness and difficulty breathing. The major blood vessels that are connected to the heart can be damaged by weakness or elevated pressure (hypertension) resulting in arterial dissection or tearing of the vessels. A person experiencing arterial dissection may have severe chest pain similar to that of a myocardial infarction. This situation is also a medical emergency. Gastrointestinal (GI) Causes of Chest Pain Some parts of the gastrointestinal tract lie between the neck and the upper abdomen. Problems with GI tract organs or organs or structures connected to the GI tract may cause pain in the chest region. The following problems may result in discomfort or pain that may be interpreted as chest pain: Gastroesophageal reflux disease (GERD), resulting often in a burning pain Hiatal hernia (burning discomfort) Rupture, perforation, or inflammation of the esophagus, resulting in moderate to severe chest pain that increases with breathing, swallowing, and/or vomiting Inflammation of the gallbladder (cholecystitis), gallstones, or intermittent or complete bile duct blockage, resulting in intermittent or constant aching pain Pancreatitis, pancreatic duct blockage, or pancreatic cancer, producing relatively constant upper abdominal and/or lower chest pain that can radiate to the back and may increase when eating Lung-Related (Pulmonary) Causes of Chest The lungs are a well-known source of chest pain when certain conditions are present. Some of the problems that cause chest pain include: Pulmonary embolism (a blood clot in a pulmonary artery can cause chest discomfort and/or shortness of breath with pain that can be sharp, stabbing, burning, or aching) Pulmonary hypertension (elevated pressure in the arteries that carry blood to the lungs can cause chest pressure or pain) Pleurisy (inflammation of the membrane that covers the lungs causes intermittent chest pain with localized tenderness in the chest with breathing and/or coughing) Collapsed lung (sudden onset of sharp chest pain on the side of the chest where the lung collapsed and shortness of breath that is relatively constant) Pneumonia (infection of the lungs that may cause sharp or stabbing chest pain especially with breathing and coughing, usually associated with fever, muscle aches, and fatigue) Muscle or Nerve Disorders That Cause Chest Pain Muscles in the chest and their supportive components such as ligaments can become injured during trauma or inflamed because of overuse even during severe coughing spells. The resulting chest pain is usually described as constant or intermittent and worsens (for example, goes from an ache to sharp pain) with activity or coughing. The area is tender when it is pressed or moved. Nerve pain in the chest can come from any chest nerves that are pinched, cut, or crushed by trauma. However, one source of burning and/or sharp pain in the chest can be caused by shingles. Herpes zoster viruses remain in the body for years after a chickenpox infection and may later reactivate and follow the nerve distribution on the chest, usually producing a sharp pain in a band on one side of the chest. This chest pain may occur before the characteristic rash of shingles develops. Bone Problems That Cause Chest Pain The ribs and the sternum are the two bone areas most often associated with chest pain. Trauma can cause rib fractures that produce sharp pain when moving the chest, especially when taking deep breaths. Rib cancers also can produce chest pain. Pain and tenderness may occur at or near the site of the cancer while the affected bone area produces a more constant dull pain or aching in the chest. Inflammation may occur at the junctions where the ribs meet the sternum. This condition is called costochondritis. The area is tender when palpated and when the person moves in certain directions or takes deep breaths. This pain is often reproducible when palpating the sternum. Psychological Causes of Chest Pain Psychological disorders such as anxiety, mental stress, and/or panic attacks can cause people to have sharp chest pains and rapid heartbeats that may result in a tightness or discomfort in the chest. The psychological disorders that cause chest pain are usually accompanied by fear, a sense of doom, or anxiety. These disorders are often accompanied by shortness of breath, dizziness, rapid breathing, and sweating along with chest pain. Other Potential Causes of Chest Pain There are other potential causes of various types of chest pain. Some examples include metastatic cancers that spread into the lungs, chronic obstructive pulmonary disease (COPD), asthma, diaphragm irritation, mitral valve prolapse (MVP), and others. Although many conditions may potentially cause chest pains, cardiac and lung problems are the chief causes of chest pain that may require emergency treatment. When to See a Doctor for Chest Pain If you are experiencing chest pain -- there are so many potential causes (some of which are medical emergencies) -- you should be evaluated by a medical caregiver to determine the underlying cause. If your chest pain is intermittent or you have problems swallowing or have a fever and/or chills, you should seek urgent evaluation by a medical caregiver. Chest Pain in Women Women who are experiencing a heart attack may have some less pronounced and sometimes different symptoms than men. For example, pain of a heart attack may be only expressed as discomfort in the neck, jaw, shoulders, and/or back. Women may have right arm pain instead of left arm pain and complain more of indigestion, nausea, and fatigue than men. Nonetheless, women with these symptoms should be seen in an emergency department to be evaluated. When Is Chest Pain a Medical Emergency? Some types of chest pain require emergency medical evaluation. This includes chest pain that: Comes on suddenly Has the characteristics of pressure, squeezing, and/or tightness underneath your sternum or in your left chest Radiates to your jaw, left arm, and/or back Is accompanied by shortness of breath, nausea, dizziness, rapid heart rate, or a very low heart rate, sweating, pale skin color, and/or mental status changes such as confusion If chest pain originates from an unknown source, the safest thing to do is to call 9-1-1 and be examined by a physician in an emergency department.