Chest Pain: Insights from Diving Medicine - Diving Medicine

Dr. Lin Zhengyan reply Diving Medicine

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Chest pain can arise from pathological changes in various tissues from the head, chest, and abdomen, as well as from the skin, muscles, bones, and deep organs.
Pain originating from superficial skin or musculoskeletal lesions is transmitted to the central nervous system via the pain sensory nerves of those areas, and the location of the pain typically corresponds to the site of the lesion.
In contrast, pain arising from internal organ lesions is transmitted through more complex neural pathways, and the pain location may not necessarily correspond to the site of the lesion.
Therefore, visceral pain can be more diffuse, harder to localize, and may radiate to areas outside the chest.

Chest pain can be classified into two main categories based on its nature and characteristics: (1) pain originating from the superficial chest wall, and (2) pain originating from deep organs (including the cardiovascular, respiratory, and digestive systems).
The former is generally simpler, while the latter is more complex.

Common causes of chest pain include:
A.
Pain originating from the superficial chest wall:
(1) Skin
(2) Muscles
(3) Bones and cartilage, spine, ribs, sternum
(4) Sensory nerves and spinal cord
(5) Breasts
B.
Pain originating from deep organs:
(1) Heart and blood vessels:
1.
Myocardial ischemia: due to increased oxygen demand (such as from exercise or hyperthyroidism), insufficient blood supply to the myocardium (angina or myocardial infarction due to coronary artery disease), or inadequate oxygen supply to the myocardium (anemia).
2.
Myocarditis, pericarditis, or valvular disease.
3.
Aortic aneurysm or dissection.
(2) Respiratory system: irritation of the trachea, bronchi, and pleura (bronchitis, pleuritis, empyema, pneumonia, pneumothorax, pulmonary embolism, tumors of the respiratory tract).
(3) Digestive system:
1.
Esophageal infections, ulcers, tumors, foreign bodies.
2.
Lesions in tissues below the diaphragm (lesions of the stomach, liver, pancreas irritating the diaphragm).
C.
Pain originating from mediastinal tissues:
(1) Mediastinal emphysema.
(2) Mediastinitis.
(3) Mediastinal tumors.
D.
Psychogenic disorders: anxiety disorders, neurocirculatory asthenia, cardiac neurosis.
Among the deep organ-related chest pains, a major source is the upper gastrointestinal tract.
The mucosa at the upper end of the esophagus is quite sensitive to pain; when stimulated by gastric acid reflux, pain may occur in the upper chest and neck.
Strong contractions of the esophageal muscles or dilation of the esophagus can lead to pain beneath the sternum.
Esophageal-related chest pain is sometimes described by patients as "heartburn," characterized by a burning sensation around the heart or in the sternum shortly after meals, which resolves quickly.
This can be caused by acidic gastric contents refluxing into the esophagus, retrograde peristalsis of the esophagus, or delayed opening of the gastroesophageal junction during swallowing.
Regardless of the cause, the fundamental mechanism involves retrograde peristalsis of the stomach.
Acute esophagitis, which irritates the esophageal mucosa and muscles, commonly leads to chest pain.
Major causes include swallowing foreign bodies, bone spurs, chemical irritation, and complications from infections, with pain typically occurring during swallowing.
Esophageal cancer itself does not usually cause pain, but if accompanied by esophagitis, chest pain may occur.
In addition to esophageal diseases, various abdominal lesions such as pyloric spasms, peptic ulcers with gastric acid reflux into the esophagus, subdiaphragmatic abscesses, herniation of abdominal organs through the diaphragm, and lesions of digestive organs such as the liver, gallbladder, and pancreas can also lead to chest pain.
It is advisable to consult a pulmonologist or gastroenterologist for diagnosis and treatment.

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Reply Date: 2001/01/06