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Chest tightness and chest pain are among the most common complaints among middle-aged and older patients. It is very important to investigate the exact nature of these symptoms, as that can sometimes suggest the possible cause.

Chest-related symptoms are often reported as sharp or dull chest pain, tightness, discomfort, a feeling of pressure in the chest, twitching, and tingling. Also, examining the duration of the symptoms and their occurrence patterns can contribute to the right diagnosis. Here we examine some of the most common causes of chest pain and tightness. The first three causes are acute, severe conditions that require immediate treatment.

Angina Pectoris

When the coronary arteries (blood vessels that supply blood to the heart muscle) are narrowed, usually due to advanced atherosclerosis, the heart muscle cannot get enough blood. This produces ischemic pain called angina pectoris. If the pain appears only during physical activity, we are talking about stable angina, and if it appears regardless of activity level it is called unstable angina. This condition is more frequent in older persons, and it represents a medical emergency that must be treated urgently to avoid its progression to myocardial infarction (a heart attack).

Heart Attack

If any of the coronary arteries gets completely occluded, it will cause a myocardial infarction -- the death of the corresponding part of the heart muscle. Patients having a heart attack usually experience very intense pain in their chest, characterized as strong pressure or burning. The pain often spreads towards the left arm and upwards to the jaw, and does not respond to standard therapy for angina pectoris. This condition can be fatal, and represents a medical emergency. Getting treatment immediately is a crucial factor for survival and the prevention of early and late complications.

Aortic Dissection

Another acute cause of chest pain is aortic dissection. It represents various types of tearing in the wall of aorta caused by a weakened aortic wall and high blood pressure. This pain is usually very sharp, has a sudden onset, and spreads to the upper back. Unfortunately, a very high percentage of these patients dies before arrival to the hospital due to severe internal hemorrhage.

Gastroesophageal Reflux Disease (GERD)

GERD is a medical condition in which the content of the stomach leaks back into the esophagus, thus causing irritation, burning sensations in the chest, burping, and bad breath. This pain can often be confused with angina pectoris. In mild and moderate cases, treatment is with medications, whereas severe cases require surgery.

Anxiety and Panic Attack

Patients with anxiety disorders frequently report a dull chest pain and tightness that last for longer periods. Panic attacks, on the other hand, can manifest as sudden-onset chest pain with an increased heart rate which can be confused with an acute heart condition, like a heart attack.

Other causes of chest pain include pericarditis, bronchitis, pneumonia, lung cancer, and chest wall trauma or inflammation.

Although the quality of chest pain can suggest the cause, every case of chest pain requires a detailed investigation in order to exclude heart-related conditions such as angina pectoris and heart attack.

If all the important causes are excluded, analgesics can be used in order to manage the pain until it subsides and eventually disappears.

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