Last week, a college principal brought two students who were engaged in boxing, a combat sport where they had thrown punches at each other, and one of them complained of sudden discomfort in the chest, including a dull ache. Chest pain can have many causes that aren’t only due to an underlying disease. Examples include heavy lifting, weight lifting, punches on the chest and trauma to the chest or swallowing a large piece of food. Chest pain can be a symptom of a heart attack, which will be discussed in detail after the general causes and management of chest pain per se.
Causes of Chest pain
As the lungs are not supplied with sensory nerve endings, a disease of the lungs is painless. However, the pleura is richly supplied with sensory nerve endings, and when it gets involved in an inflammatory process, the pain is severe as the two inflamed surfaces rub against each other with each act of inspiration. The pleura is a two-layered serous membrane that surrounds the lungs and lines the inside of the chest cavity. It acts as a protective and lubricating layer, allowing the lungs to move smoothly during breathing. The two layers are the visceral pleura, which directly covers the lungs, and the parietal pleura, which lines the chest wall. Similarly, the chest wall is well supplied with sensory nerve endings, and hence all disease conditions of the chest wall can be very painful.
According to a publication in PubMed, June 2022 Prevalence of Amoebiasis and Associated Complications in India, the Prevalence of amoebiasis ranged from 3-23% in the asymptomatic population, 0.64-11% in symptomatic patients, and 1-17.5% in HIV-infected patients. The highest prevalence was seen in Tamil Nadu, Andaman and Nicobar Islands, and North East India. Extra-intestinal invasion of Entamoeba histolytica leading to complications such as amoebic liver abscess, amoebic colitis, colonic perforation and ameboma were also reported. Such complications have the potential to increase healthcare burden and may prove to be fatal. Amoebiasis remains a significant public health issue in India, responsible for diarrheal diseases, causing significant morbidity and mortality. Entamoeba histolytica is the principal protozoan parasite associated with amoebiasis. Public health efforts should be directed towards its control and better diagnostic methods should be employed for distinguishing between pathogenic and non-pathogenic species of Entamoeba.
Myalgia of the chest muscles
A minor inflammation of the chest muscles, but pain can be severe, local tenderness, any movement in which the affected muscle is used induces pain, e.g., moving the trunk from side to side or bending: if the intercostal muscles are involved coughing and deep inspiration may be painful. Intercostal muscles are a group of skeletal muscles located between the ribs, playing a crucial role in breathing and chest wall movement. They are organized into three layers: external, internal, and innermost intercostals. The external intercostals, being the most superficial, contract during inhalation, expanding the chest cavity. The internal intercostals contract during forced expiration, helping to lower the ribs. The innermost intercostals are the deepest layer and function similarly to the internal intercostals, assisting in forced expiration.
Pleurisy
Pleurisy is an inflammation of the lining of the lungs (pleura) that causes sharp chest pain, often worse when breathing or coughing. It can be caused by various factors, including infections, autoimmune diseases, or lung conditions. Symptoms typically include sharp, localized chest pain that worsens with breathing or movement, and may also include shortness of breath and a dry cough. This results from inflammation reaching the visceral pleura from the underlying lung. common causes: tuberculosis, at first dry, i.e., without fluid; rubbing of roughened surfaces of the two layers of the pleura produces excruciating pain with each act of inspiration, along with pleural fibrous sound heard on auscultation. Auscultation is a medical examination technique where a healthcare provider listens to sounds within the body, typically using a stethoscope, to detect potential medical conditions. This involves listening to sounds produced by the heart, lungs, intestines, and other organs to assess their function and identify any abnormalities. Local tenderness on the chest do cause considerable pain.
Amoebic liver abscess
Amoebic infection of the liver is common in India. An amoeba is a single-celled organism with a flexible, changing shape, commonly found in water. The parasite lives only in humans and is passed in the stools of an infected person. A person gets amebiasis by putting anything in their mouth that has touched infected stools or by eating or drinking food or water contaminated with the parasite. It can also be spread sexually by oral-anal contact. The liver is enlarged and very tender, right lower intercostal spaces are also tender, low-grade fever, which becomes high if septic infection supervenes; history of amoebic dysentery. In chronic cases, mild diarrhoea alternating with constipation, and flatulent dyspepsia, is also known as gas-bloat syndrome, a condition characterized by a combination of symptoms including indigestion, gas, bloating, and discomfort in the upper abdomen. It’s often associated with problems like poor digestion, which can lead to undigested food accumulating in the gut. The symptoms may be present for years before the liver becomes involved, the abscess may burst into the right pleural cavity or the right lung; the patient then brings up large quantities of chocolate-coloured sputum.
Spontaneous pneumothorax:
Presence of air in the pleural cavity. Caused by a tear in the visceral pleura. It can cause sudden severe chest pain and dyspnoea; Dyspnoea, also known as shortness of breath, is a subjective sensation of uncomfortable or difficult breathing. Tuberculosis of the lung is not an uncommon cause in India. As infection enters the pleural cavity, it is usually accompanied by an effusion, which is an abnormal collection of fluid in hollow spaces or between tissues of the body. For example, a pleural effusion is a collection of fluid between the two layers of membrane covering the lungs.
Rib fractures can also cause pain in the chest, local tenderness, and difficulty in breathing. These are some of the causes of chest pain the other important conditions, like chest pain and heart attack, and management will be narrated in the coming issue. (To be concluded).