Dr Sukhjinder Nijjer
Consultant Cardiologist
Expert in Chest Pain and Chest Tightness
Chest pain and tightness
Chest pain and tightness
Chest pain or tightness of the chest can be a worrying symptom and is frequent reason that many people attend emergency departments. If you have had chest pain, both you and your Doctor will want to complete some tests to determine the cause. There are many potential reasons to have chest pain and it is natural to think of the heart as a cause.
In many cases, you may have been referred to a ‘Rapid Access Chest Pain Clinic’ – which are typically nurse-led clinics. Dr Sukhjinder Nijjer, Consultant Cardiologist, is an expert in the management of chest pain and can provide a rapid and complete assessment that will get to the bottom of the problem quickly, and without delay.
Dr Nijjer will take a complete description of your symptoms and understand them within the context of your medical history and your lifestyle. Dr Nijjer, a BUPA-approved Cardiologist, will then undertake an examination and perform core cardiac investigations. He may then recommend further specialist tests, including stress testing or CT coronary angiography. Dr Nijjer will determine if your symptoms are related to the heart, and if they are, what treatments are needed. Dr Nijjer will treat you according to your lifestyle and your wishes.
Many people can suffer a discomfort in the chest and this can create concern. When thinking of your pain, try to think about the nature of the symptom.
• Is it sharp or dull?
• Is it like a band across the chest or does it feel like a needle stabbing in the chest?
• Does it happen when you rest, lie down or when you exert yourself. Does taking a deep breath make the chest pain worse?
• Is your breathing affected by the discomfort?
• Is the discomfort worse with food?
• Is there a feeling of reflux or burning in the chest?
• Is the discomfort worse with stress or worry
It is important to discuss the nature of the discomfort and how it relates to your activities. Send some time thinking about your symptoms before your Clinic appointment with Dr Nijjer and he will discuss this in detail with you.
What causes chest pain or tightness?
There are many reasons for you to have chest pain. Some reasons are benign and less worrying from the medical point of view, but may still be uncomfortable. Dr Nijjer will help to identify the heart-related causes but sometimes he will find there are other medical reasons for you to have the symptoms. If necessary, Dr Nijjer will identify other Consultants who specialise in those conditions to help treat them.
We can divide the causes of chest pain as:
- Cardiac causes
- Lung causes
- Gastric causes
- Musculoskeletal causes
- Anxiety causes
Cardiac causes of chest pain
Cardiac related causes:
- Angina: this is a recurrent chest tightness that occurs when you undertake activity and is relieved by rest. This is caused by a narrowing of the heart arteries such that there is insufficient blood supply to the heart muscle. Recurrent angina should not be ignored and requires heart investigations.
- Unstable Angina: this is a central chest discomfort that is occurring at rest or with very little activity. When angina first starts, it may do so in this manner. If your symptoms are rapidly getting worse, with less activity to trigger it, this is a concerning sign and warrants prompt investigation and treatment. This is caused by a heart artery narrowing that has suddenly got worse.
- Heart Attack: a chest discomfort associated with breathlessness, nausea and feeling unwell can represent a heart attack. Ongoing pains that last longer than 20 minutes should be treated as an emergency and you should call for an ambulance. Do not try to head to the hospital on your own, it is safer to call for emergency services.
- Coronary microvascular disease: in this condition, the microvessels deep in the heart do not respond in the normal way. This can require specialist tests to diagnose. It is more common in diabetics.
- Coronary vasospasm: in this condition you may develop recurrent chest pain consistent with angina but your heart arteries appear normal. The artery has a tendency to spasm – or close down on itself, often without warning. This can be recurrent and very troublesome. This condition requires careful investigation to identify and treat.
- Pericarditis: a sharp discomfort in the chest that is worse with breathing and better in certain positions can represent pericarditis. This is caused by an infection of the pericardium – the outer lining of the heart. This can be very uncomfortable and requires an ECG, echocardiogram and blood tests to make a refined diagnosis.
- Myocarditis: this is a very serious condition in which there is inflammation of the heart. This is typically caused by a virus and can be very serious. You may require specialist testing to determine this.
- Arrhythmia: Rapid and irregular heart beats can cause a sensation of chest tightness. This can be purely due to the arrhythmia. In some cases, it can be because you have some underlying heart artery narrowings – and when the heart is beating uncontrollably fast, you can develop chest pain even at rest.
- Valvular disorder: Valvular problems of the heart, such as Aortic Stenosis, reduce the blood flow out of the heart and are associated with chest pain on exertion.
- Abnormal heart muscle (Cardiomyopathy): Some hearts develop an excessive thickness (called hypertrophic cardiomyopathy) so there is compression of the heart arteries during exercise. This can manifest as chest pain.
Lung causes of chest pain
- Lung clots: it is possible for clots to develop in the deep veins, in the pelvis or the legs. These clots can move to the lungs and cause a dangerous condition called pulmonary embolus. This requires prompt assessment and typically requires detailed scans to detect.
- Lung infection: both bacterial and viral infections of the lung can cause a chest discomfort. This can be associated with fevers and a cough. Dr Nijjer may perform blood tests and chest X-ray to help determine the cause. Some patients have recurrent chest infections due to COPD or emphysema. Others have bronchiectasis – a condition of lung scarring caused by recurrent infections.
- Lung inflammation: some lung conditions cause inflammation of the lung which can cause pain. Even chronic inflammatory conditions such as lung fibrosis can cause pains.
Gastric causes of chest pain
- Gastric Reflux: The stomach and the food pipe (oesophagus) are common causes of discomfort. These symptoms may be worse after eating and certain acidic foods, such as coffee or apples may make the symptoms worse. You may feel a burning sensation in the upper part of your tummy and there be an acidic taste in the mouth. You may even get water salivating in your mouth.
- Excessive acid and gastric ulceration: Many patients have excessive acid production in their stomachs and they may need medications to reduce the acid. If untreated, excessive acid can cause stomach ulceration. Recurrent pain, that is made worse by food may need endoscopy.
- Helicobacter Pylori: Some patients can have a bacterial infection in the stomach called Helicobacter Pylori. This bacteria triggers excessive acid production and requires a longer course of antibiotics to clear.
Musculoskeletal causes of chest pain
- You may have developed an injury to your chest muscles after exercise or lifting something awkwardly. This may cause a constant throbbing sensation.
- In some cases, viral infection of the cartilage around the rib cage can cause a recurrent sharp discomfort. This may get worse when your chest is pressed upon.
- Shingles – Shingles infection is caused by the same virus as Chickenpox and it resides within the nerve endings. It can return when you are run-down and cause a severe blistering rash across the chest and back. This can be very uncomfortable and is another cause of chest pain.
Anxiety as a cause of chest pain
- Work related stress and anxiety are a major cause of chest discomfort and trigger significant chest symptoms.
- Some patients may have symptoms suggestive of a panic attack with a raised heart rate and hyperventilation. In this situation, it is important to exclude other medical problems. Thyroid disorders, in particular an over-active thyroid, can cause these symptoms and can readily be diagnosed using blood tests.
What tests are needed for chest pain?
Dr Nijjer will assess your symptoms very carefully. He will perform a complete examination and assess you for heart murmurs. He will organise an electrocardiogram (ECG) and echocardiogram. Further testing will be determined according to your symptoms and what the likely diagnosis is. You may require sophisticated blood tests to measure cardiac enzyme levels.
Others may require advanced imaging tests including non-invasive cardiac CT coronary angiography or cardiac MRI. Some patients will have stress testing, which can be either on exercise or using a medication.
In those patients in whom we believe there is severe coronary artery disease, Dr Nijjer may need to perform invasive coronary angiography. In many cases, this can be performed using the hand artery and this allows the procedure to be a day-case one.
What treatment is needed for chest pain?
The treatment will depend upon the cause of the chest tightness. Once this has been determined, the correct management can be started according to the test findings. Dr Nijjer will guide you through your treatment and will provide a personalised approach that combines the latest International Guidelines and research evidence.
Whilst there are many approaches to treating a condition, Dr Nijjer will tailor his approach to fit into your life. When it is suitable, a holistic approach can be sought.
More Information from the British Heart Foundation
More information is available on the British Heart Foundation (BHF) website.
The page on Angina is found here.
Click here to download a PDF discussing Angina in more detail.
Help Your Heart
If you have any concerns regarding your heart health, then please seek a referral to Dr Nijjer.
Call the Team: Monika, Amy, Charlotte, Erin or Grace:
0203 9838 001
Email: Secretary@DrNijjer.com
Dr Nijjer can be seen at :
68 Harley Street, London, W1G 9QP
He also practices at Cromwell Hospital, Wellington Hospital, BUPA Clinics, BMI Syon Clinic as well as Imperial Private Healthcare.
