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Dull Chest Pain

Dull Chest Pain

Chest pain or a feeling of pressure in the chest often causes people to feel anxious, mainly due to its association with heart attacks or other serious cardiovascular diseases. However, doctors have to consider the extensive differential diagnosis of chest pain. An accurate diagnosis can be made only after considering the nature and location of pain along with the associated symptoms. The following write-up provides information on the causes of a dull chest pain.
Anannya Saikia
Last Updated: Feb 14, 2018
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Chest pain is often viewed as a warning sign of cardiovascular problems, which is why an episode of chest pain is bound to evoke fear in any individual. However, pain in the chest could be caused due to various medical conditions. The medical conditions that may cause pain in the chest could be cardiovascular, pulmonary, gastrointestinal, musculoskeletal, neurological, or psychogenic in nature. The nature, severity, location, precipitating factors, time of onset, and duration for which the pain lasts, are taken into consideration while ascertaining the underlying cause of chest pain.

Dull and diffuse chest pain, which is difficult to localize, could actually be visceral pain. It is the pain that occurs when the nociceptors (sensory neurons that send nerve signals to the brain and the spinal cord in response to pain) of the chest cavity get activated. Ischemia (disruption of the blood supply) or inflammation of the structures or the organs enclosed in the chest cavity could give rise to visceral chest pain. Stretching of the muscles of the chest wall could also be a contributing factor behind a dull chest pain.

Contributing Factors

The chest cavity which is enclosed by the rib cage comprises vital organs such as the heart and lungs. Pain can be felt in the chest if the heart, lungs, or the intercostal muscles located within the ribs get affected due to blunt trauma or medical conditions. Here are some of the medical conditions that may cause a dull pain in the chest.

Coronary Artery Disease

Coronary artery disease occurs due to the buildup of plaque or cholesterol deposits in the arteries that supply blood to the heart. Plaque buildup can also cause atherosclerosis (hardening of arteries). As a result, coronary arteries become constricted, which in turn affects the flow of blood to the heart. Angina is the most characteristic symptom of coronary artery disease.

The term 'angina pectoris' refers to a dull, squeezing chest pain that occurs when there is an imbalance in the amount of oxygen required by the heart and the amount of oxygen delivered through blood. Angina is categorized into stable angina and unstable angina. Stable angina is characterized by a dull pain in the chest. It is accompanied by shortness of breath, nausea, fatigue, dizziness, or restlessness. It is usually triggered by physical activity or stress. The pain may also radiate to the neck, shoulder, jaw, or back. The symptoms of stable angina can be alleviated with medication and rest.

The symptoms of unstable angina are similar to those of stable angina. However, there is no recognizable pattern or trigger in case of unstable angina. The pain starts suddenly, and often worsens with time. The symptoms may last longer than fifteen minutes, or occur even when the affected individual is resting. The treatment options for angina may include angioplasty (opening the constricted coronary arteries), stenting (placement of stent to keep the artery open during angioplasty or prevent the recurrence of blockage), drug therapy, and lifestyle changes.


Myocardial Infarction

Myocardial infarction, which is commonly referred to as heart attack, occurs due to an interrupted supply of blood to a section of the heart. A blockage in the coronary arteries affects the supply of blood and oxygen, thereby causing a part of the heart muscle to get damaged. The symptoms of a heart attack include a dull, constricting pain, anxiety, lightheadedness, shortness of breath, nervousness, sweating, irregular heart rate, etc.

Besides the aforementioned heart problems, heart valve disease or inflammation of myocardium (lining of the heart) or the endocardium (inner lining of the heart chambers and the valves) could also cause chest pain. The treatment of a heart attack may involve oxygen therapy, angioplasty, coronary artery bypass grafting, or the use of drugs such as nitroglycerin, anticoagulants, beta blockers, ACE inhibitors, etc.


Disorders of the Esophagus

Chest pain resulting from esophageal disorders may occur due to acid reflux disease, esophagitis (inflammation of the esophagus), or esophageal spasms. Acid reflux disease is characterized by the regurgitation of the gastric juices or the contents of the stomach towards the esophagus. Heartburn, which refers to a painful, burning sensation in the chest, is the characteristic symptom of acid reflux.

Esophagitis could occur in people affected by acid reflux. Heavy smokers and those who indulge in excessive consumption of alcohol are more likely to get affected by inflammation of esophagus. Esophageal spasms refer to the contractions in the smooth muscle of the esophagus. Those who experience esophageal spasms are likely to experience difficulty in swallowing. They may experience a lump in throat sensation. The nature of pain that may be felt in case of these spasms is often mistaken for angina. While the treatment of acid reflux involves the use of antacids and lifestyle changes, the use of anti-inflammatory drugs, antacids, or painkillers may be recommended for treating esophagitis. Muscle relaxants are usually prescribed for treating esophageal spasms. If drug therapy doesn't help, surgery may be recommended for treating esophagitis or esophageal spasms. The affected individual must refrain from consuming food items that may trigger heartburn.


Costochondritis

Chest pain could be indicative of a medical condition called costochondritis. Costochondritis is said to occur when the costal cartilages that attach the ends of the true ribs to the breastbone become inflamed. Viral, bacterial, or fungal infection of the rib joint, blunt force trauma to the chest, or repeated motion injuries could cause costochondritis. The affected individual is likely to experience a dull, constant pain in the chest. The pain usually worsens when the person coughs or sneezes. Rib injuries and intercostal strain could also cause pain in the chest region. The symptoms of the aforementioned conditions can be alleviated with the help of drug therapy. It's essential to avoid indulging in strenuous physical activities so as to prevent the symptoms from worsening.


Conditions Affecting the Lungs

Chest pain could also occur in people affected by pulmonary hypertension, pneumothorax, or pneumonia. Pulmonary hypertension occurs due to elevated blood pressure in pulmonary arteries that carry venous blood from the heart to the lungs. People who suffer from liver cirrhosis (scarring of liver), chronic lung disease, congestive heart failure, pulmonary embolism (the presence of blood clot in the lungs), etc., are likely to get affected by pulmonary hypertension.

A person is said to suffer from pneumothorax (collapsed lung) when air collects in the pleura, thereby causing pressure to build up over the lungs. Chest pain is experienced due to the inability of the lungs to expand during inhalation of air. Pneumonia is a lung infection that could be caused by bacteria, viruses, or fungi. It affects the alveoli, which are tiny sacs in which the exchange of carbon dioxide and oxygen occurs. Chest pain could also be experienced by people who are affected by lung cancer. The treatment of chest pain caused by these conditions will vary, depending on the underlying cause. While air from the pleural space must be removed for treating pneumothorax, the use of painkillers and anti-inflammatory drugs is recommended for treating inflammation. Antibiotics, antiviral drugs, or antifungal drugs are prescribed for treating bacterial, viral, or fungal lung infections respectively.

Besides the aforementioned conditions, a dull pain in the chest could also be caused by panic attacks or hyperventilation syndrome. It could even be referred from the organs in the abdominal cavity. Since chest pain could be a symptom of various medical conditions, some of which may be of a life-threatening nature, it becomes extremely essential to seek medical help. Besides conducting a physical examination and analyzing the medical history, doctors also ask the patient to describe the nature of the pain. Sometimes, doctors may be able to rule out certain conditions just by studying the characteristics of the pain experienced by the patient.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.
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