Pediatric Heart Expert Forum
What Type of Chest Pain Is Most Worrisome?
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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What Type of Chest Pain Is Most Worrisome?

Hello Dr. Boris! Yeah it’s me again, the one who keeps asking about my constant heart palpitations. Though I'm still very concerned about that, this is another question that is more general that I think will clear up some confusion that a lot of people seem to have; because I tried to ask people here on MedHelp first before going to the "Ask A Doctor Forum" but I kept getting different answers. I've heard two completely different things about chest pain. I heard that if you have chest pain with exertion, like while exercising, that it is NOT a good sign and it probably means it is heart related. Well, I've heard the complete opposite too. I've heard that chest pain with exertion can be muscle pain, or something else not necessarily heart related. Which of these is true? Or are both true? Because I have chest pain sometimes while I move around or exercise yet I also have it sometimes when I rest, laugh, or breathe. Some days it lasts for long, other days it goes away more quickly. Sometimes my chest wall and rib area are even tender to the touch as well. I'm just a bit confused if chest pain with exertion is a bad sign or not. And where should you be most concerned about having chest pain, and what does this usually feel like? I hope I made myself clear enough, I didn't really know how else to word it. Well thanks again for all of your help!
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Dear Chrissy,

Chest pain with exercise or exertion is not straightforward.  There are many factors associated with chest pain that can give us a clue as to whether it is associated with myocardial ischemia (decreased blood flow to the heart) or chest wall pain.  I am not going to try to diagnose you through this forum, as I don’t have enough information to be able to do so; this is something that your physician should be doing.  However, the classic chest pain associated with cardiac ischemia is a crushing pain, the worst EVER, in the middle of the chest.  It can radiate down to the upper abdomen, up to the jaw, or out to the left arm.  It can make you feel nauseated.  It is not reproducible, or doesn’t worsen, with pushing on it, and it usually lasts about 20-30 minutes.  You can have cardiac chest pain with exercise, but you can also have chest wall pain with exercise.  

Finally, instead of working through a forum like this to get an answer, you really need to work with and to be seen by your doctor to not only find out whether this is normal, or not, but also to manage your symptoms.  If you are not getting the care that you need, then you need to switch providers.  However, continuing to attempt to be evaluated through an online forum is only delaying or confounding your care at this point.
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I am not a doctor.

The answer is it depends.

Chest pain with exertion can be bad, but it depends on the type of pain it is.  Bad pain is dull and feels like pressure or sometimes burning.  "Good" pain is typically sharp and can be reproducable , such as when you touch your ribs and they are tender.  I get sharp  chest pains when I'm working my heart rate in the 90%-100% region, but that's just the way my body is.   There can be many exceptions, but this is the general rule in adult cardiology with exertional chest pain.

Chest pain at rest can be caused by many things, including GERD, esophageal spasms, and different infections in the chest. Going to the doctor is really the best way to figure things out. Sometimes excluding (ruling out) things that cause chest pain can be just as important as finding out what does.
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Jeffrey R Boris, M.D.Blank
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