Nose Bleeding In Children: Why?

It can be a worrying experience if your child has bleeding from nose (epistaxis). However, most of the time the nose bleeding is not caused by serious problems.

Nose bleeding usually occurs on one side of the nostril. It is commonly due to injury to the inner lining (mucosa) of the front part of the nose, such as:

• nose picking (esp with sharp fingernails)
• nose blowing & rubbing
• nose inflammation / infection
• foreign body in the nose
• nose trauma (eg. from a blow on the face)

The bleeding point is most likely at the front part of the nose septum (Little's area) where the blood vessels are most abundant. You may see this area if the nose bleeding is not too profuse. 

       Little's area

When the bleeding occur, sit the child upright and tilt his/her head forward to prevent the blood from flowing backwards into the mouth. Then pinch the nose with your thumb and index finger for at least 5-10 minutes to compress the bleeding point at Little's area. If the bleeding does not stop and you are worry, it is wise to bring your child to a doctor.

Nose bleeding can be recurrent, especially in children with underlying allergic condition such as allergic rhinitis. Besides, dry air or dry weather can cause nasal mucosa irritation and increase the chance of nose bleeding.

Very rarely, nose bleeding in children can be caused by more serious disorders especially when:

• there are bleeding elsewhere other than the nose (gum bleeding, bruises, bloody stool etc)
• the bleeding does not stop or takes a longer than usual time to stop
• very frequent nose bleeding episodes

A few more serious causes of nose bleeding in children include:

• blood coagulation disorder (congenital or acquired)
• low or abnormal platelet function
• blood cancer (leukemia etc)
• nose tumour

Nose bleeding in children is usually harmless. If you are in doubt, please consult your doctor for confirmation.

Jaw Pain: Is It TMJ Disorder?

Jaw pain can be irritating and persist for a long time. You can't eat properly and you can't laugh out loud. If you have jaw pain on only one side, it can be due to the problem within the joint (temporomandibular joint - TMJ) or other structures around the joint.

TMJ is a joint that is involved in opening and closing our mouth. You can locate the joint by placing your finger directly in front of your ear and then open and close your mouth. The movement you feel is your TMJ in action.

       Temporomandibular joint

The problems within the TMJ that cause pain may arise from the joint itself, the bones that make up the joint, and the surrounding muscles/tendons. It is simply referred as TMJ disorder. In most cases, the joint is "damaged" and becomes sore and stiff due to various reasons. These reasons are usually associated with overuse or "abuse" of the TMJ, such as:

• habitual teeth grinding
• habitual fingernails biting
• excessive gums chewing
• always chew on one side
• misaligned teeth
• open the mouth too wide frequently
• aging of joint (arthritis)

This is the pure TMJ disorders and the pain is usually felt when you use your TMJ such as opening your mouth. When you do not move your mouth, there is usually no pain. The pain may be worse when you open your mouth after a long period of time resting it. Sometimes you can feel the clicking sound from the TMJ when you open your mouth. It can also be accompanied by headache, giddiness or ear pain.

As the causes of these TMJ disorders are overuse/abuse of the TMJ, you should identify the reason and try to correct or avoid it. Rest your jaw by avoid excessive chewing, chewing hard food or opening the mouth too wide. Cold & heat application and some regular jaw exercise by opening and closing your mouth gently may help to prevent stiffness and improve the pain.

The pain can improve and diminish within few days or weeks but sometimes it can last for months or years. You should seek advice from your doctor if in doubt.

However, if you have recent serious trauma or injury to your face, then the pain at TMJ could be due to fracture of the bone or dislocation. In this case, you should see your doctor for a scan.

Other reasons that can cause pain around the TMJ include:

• Toothache or tooth abscess - in this case the pain is usually persistent and accompanied by swelling around the area or fever. The pain may be worse when you knock on the problematic tooth. See a dentist if you suspect this.

• Ear infection - pain is usually persistent and may be aggravated by moving the jaw, as the external canal and middle ear are just next to the TMJ. Associated symptoms include ear discharge, hearing loss and tinnitus (ringing sound). A check into the ear by your doctor can confirm this.

• Headache - headache can cause pain around the TMJ area, but usually you will have pain at other area of the head too.

• Trigeminal neuralgia - this nerve disorder can cause severe pain that mostly originate from the jaw area and radiate towards your forehead, nose and chin. Touching the face may make the pain worse.

Of course there are other causes of jaw pain which are not mentioned here. You should consult your doctor if you think that the jaw pain is not a pure TMJ disorder.

High Triglycerides: Mostly Lifestyle Related

Triglycerides (TG) is a form of fat in the body. People with extremely high triglycerides level may have higher risk of heart attack, especially for those with low HDL-cholesterol / high LDL-cholesterol level or those with other risk factors such as diabetes mellitus, hypertension and smoking. 

National Cholesterol Education Program has given a guideline for normal & high triglycerides level:

• Normal               :  < 1.7 mmol/L (150 mg/dl)
• Borderline high    :  1.7 - 2.3 mmol/L (150-199 mg/dl)
• High                    : 2.3 - 5.6 mmol/L (200-499 mg/dl)
• Very high            :  >5.6 mmol/L (> 500 mg/dl)

Some of the causes of high triglycerides:

• Genetics
• Obesity/overweight
• Diabetes Mellitus
• Alcohol
• High carbohydrates/fat diet especially refined carbohydrates
• Hypothyroidism (though more on high cholesterol)
• Nephrotic Syndrome (though more on high cholesterol)
• Some drugs (thiazides, estrogen, tamoxifen, steroids, isotretinoin)

High TG level below 11.3 mmol/L (1000 mg/dl) usually does not produce any signs and symptoms. If the level is above 11.3 mmol/L, it may give rise to recurrent abdominal pain (chylomicronemia), skin lesion (eruptive xanthomas) and increased risk of acute pancreatitis. Hypertriglyceridemia is also related to fatty liver which may cause mild discomfort at the right upper abdomen.

       Eruptive xanthomas: yellow papules on red base

The serum level of TG is well-known to be labile and may fluctuate a lot depending on a person's diet and lifestyle prior to the test. Blood test for TG usually is done together with cholesterol level and fasting of at least 10-12 hours is ideal. Excessive alcohol or high carbohydrates/fat intake for the last 2 weeks prior to the blood test may affect its result. 

If your TG level is high (>5.6 mmol/L), doctors will usually prescribe a medicine to lower it. Medical treatment available currently includes fibrates, high dose niacin and high dose omega3. Level above 11.3mmol/L must be treated in order to reduce the risk of acute pancreatitis.

If TG level is at the high but less than 5.6 mmol/L, then the treatment will depend on the presence of other secondary causes and the cholesterol profile. If the cholesterol (HDL/LDL) level is not favourable, then cholesterol lowering medicine (statin) may be given priority. If secondary cause is identified (such as alcohol, diabetes, obesity etc), then it should be managed or treated accordingly first.

Diet & lifestyle control can do marvel in controlling TG level. Weight reduction, regular exercise, reduce/stop alcohol intake, reduce fat & refined carbohydrates (sugar/white flour) intake can help to improve TG level.

So it is not just too much fat, too much bad carbohydrates/sugar will also raise your TG level.

Chest Pain: Is It Digestive Tract?

Chest Pain: Is It Digestive Tracts?

Pathology in the upper digestive tract which are the esophagus and stomach can give rise to chest pain, though they are most commonly felt at the lower chest or upper abdomen area (epigastrium). 

Common associated symptoms in esophagus disorders include dysphagia (difficulty in swallowing) & odynophagia (pain when swallwong), while in stomach disorders, abdominal bloating, nausea, vomiting, indigestion are common related symptoms.

Gastroesophageal Reflux Disease (GERD)

This condition is caused by back-flow of acidic stomach content back into the lower part of esophagus. There is a muscular "valve" between the lower esophagus and stomach which allows only one-way flow of food content from the esophagus towards the stomach. However, due to some condition, the "valve" does not function properly and allows the food to flow backwards.

There are many condition which can give rise to GERD, such as:

- pregnancy

- obesity

- prolonged/excessive straining over abdomen (coughing/vomiting/physical exertion)

- certain foods

- smoking

- hiatal hernia

The chest pain caused by GERD is typically referred to "heartburn", where the pain is "burning" in nature and radiate upwards towards the neck/throat. It may be accompanied by bitter taste in the mouth.

Esophagitis

Infection or inflammation of the esophagus can cause pain along the chest area. The pain may be made worse after food when the food bolus pass through the inflammed area.

Esophagus spasm

Either irregular or regular esophagus spasm can cause pain, mostly after food intake. It is not common and the cause is unknown. The pain is usually intermittent and can be severe.

Esophageal cancer

Esophageal cancer most commonly occurs at the lower part of esophagus and pain is not a usual symptom. Most sufferers will complain of dysphagia or food stuck at the lower part of the esophagus. More advanced case can give rise to poor appetite and weight loss, as in all type of cancers.

Peptic ulcer disease

This is a common disorder and is highly related to Helicobacter pylori infection, regular use of NSAIDs and blood-thinning drugs. The ulcers can be at the stomach or upper portion of the small intestines (duodenum). Besides pain over the chest (heartburn) or upper abdomen especially between meals and at night, sufferers may also complain of bloating, nausea & vomiting.

Peptic ulcers can be life-threatening if it is bleeding profusely. Thus, in case of chest discomfort accompanied by vomiting blood (hematemesis) or passing black stool (melena) or anemia (pale), the patient has to seek medical attention immediately.

Gastritis

Gastritis is a term used to described inflammation or irritation of stomach lining. It is a common diagnosis made by doctors for upper abdominal pain. The pain can be felt at chest area as heartburn with abdominal bloating, nausea & vomiting. The causes and symptoms of gastritis are similar to peptic ulcer disease. Doctors can only differentiate both of them by doing an oesophageal-gastro-duodenal-scopy (OGDS).

Click here for clues on how to differentiate chest pain.

Children With Foot Pain At Night: Growing Pain?

It is very worrying for parent whose child suddenly wakes up in the middle of the night crying and complaining of leg or foot pain, and it recurs few other nights. Young children may not describe the pain and locate the pain accurately, this makes the parent even more anxious.

It's not easy to diagnose leg/foot pain in children. The most important thing to do is to rule out serious illness or disorder associated with the pain.

There is a condition often referred to "growing pain", which is completely harmless and is a diagnosis of exclusion. The typical features for a growing pain are:

• Pain in foot or leg (one or both sides) mostly occurs at night only
• Occurs intermittently and not on every night
• Pain lasts for few minutes and the child can go back to sleep
• No swelling, redness over the pain area
• Not worsening by touching/pressing the pain area
• Completely well in the morning, without pain and limping

By using our common sense, if it is something more serious, it should be:

• Pain during both daytime and night time, almost everyday
• Pain getting worse and worse with time
• There is swelling or redness at the pain area
• The child resists someone from touching the pain area
• The child has other symptoms other than pain
• The child has limp and discrepancy in leg length

There are a few conditions to consider for foot or leg pain in children

Injury (bony fracture, ligament sprain, muscle strain)

• does the child has recent fall or trauma?
• pain exists all day long, not just night time
• there can be swelling, skin lesion and especially pain to touch
• limping is likely

Arthiris (juvenile idiopathic arthritis)

• typically having morning stiffness 
• commonly affects more than one joint
• can occur in any body parts
• pain may continue in daytime
• may have swelling in the joints
• may have other symptoms such as fever & skin lesion

Tumour (benign or cancer)

• pain during day and night time, though typically worse at night
• pain wosening with time
• can feel the swelling in later stage
• may have limp and discrepancy in leg length
• more common on long bones - femur, tibia (not foot)

Kohler's disease

• avascular necrosis of a bone in the foot (navicular bone)
• rare and benign condition
• may have pain during day and night time
• may have swelling

Thus, if your child with foot pain (either one foot or both feet) at some nights and is completely well during the rest of the day, with no swelling or deformity, then it is likely a "growing pain". It is also important to check whether your child has a normal foot arch.

Growing pain is believed to be a muscular pain and more common in age 2-8 years old. Though it is harmless, it is really painful to the child. You can massage or stretch the pain area or apply warm towel to try to relieve the pain. If the pain is intense, analgesics can be given for short term relief. 

However, it is possible that there is actually no pain but the child is just trying to seek parent's attention.

If you are not sure what is happening to your child with foot/leg pain, please consult your doctor. The doctor is likely to ask you the questions above and examine your child. In some cases, an X-ray may be required.

Heel Pain When You Step: Likely Plantar Fasciitis

There are many people complaining of foot pain when they make their first few steps after getting down from bed. If you have this problem, then you may have a condition calls "plantar fasciitis".

Plantar fasciitis is the commonest cause of foot pain or heel pain. The pain is sharp and can be so severe until you can't put your foot on the floor. 

Plantar fascia is flat sheet of ligament that supports our foot arch from toes to heel. When this fascia is inflamed, it will cause pain. There are many reasons for inflammation of plantar fascia, and almost all of them are related to injury to the fascia, especially at the heel area where the pain is commonest.

The injury to plantar fascia is likely to be caused by repeated minor trauma to the foot. The risk factors include

• overweight
• prolonged standing
• frequent walking, running, jumping esp on hard surface or bare-footed
• wearing ill-fitting or inappropriate shoes
• abnormal foot arch
• previous foot injury
• tight calf muscles

In many cases, the cause of plantar fasciitis is multiple factors.

The heel pain is more obvious when you start walking after the foot does not bear weight for some time, such as after sleep or prolonged sitting. It may be worse when climbing stairs or at the end of the day.

Nevertheless, not all heel pain is plantar fasciitis. Sometimes it can be due to other reasons such as foot bone fracture, nerve entrapment, bone pathology etc. Thus, a foot X-ray is sometimes essential when the diagnosis is in doubt.

As plantar fasciitis occurs after prolonged repetitive trauma, it also takes quite a long time to recover, as the damaged ligament takes time to heal. The healing time takes longer because we are unable to rest the plantar fascia completely for it to heal as we still need to walk everyday.

To facilitate healing or to relieve the heel pain, you may take the measures listed below, depends on what your problems are. If you wish to prevent plantar fasciitis before you have it, you may also do these.

• lose weight
• avoid prolonged standing
• reduce exercise intensity (walking, running, jumping)
• avoid exercise on hard surface
• avoid bare-footed on hard surface
• wear proper shoes
• replace worn-out shoes
• put proper shoes in-sole

Other methods to relieve heel pain

• ice therapy (for 15 min/day)
• stretching 
• toe stretching (extend the toes with your hand and hold for 30 sec)
• calf stretching (hands against wall with affected side knee straight & other side knee bend, hold for 30 sec)
• orthoses - custom made shoes or insole
• night splinting - ankle fixed at 90 degree
• medication
• oral anti-inflammatory drugs (NSAIDs, steroids)
• steroids injection
• surgery

The first few methods to do are usually ice therapy and stretching exercise for 6 weeks, apart from those preventive measures. If the pain does not get any better, then you can add in orthoses, night splinting & medication. If nothing works for a period of 12 months, then you may consider surgery.

Study shows that 90% of plantar fasciitis cases can heal within 12 months. It can heal by itself if you give your foot enough chance to rest. 

Chicken Pox: How Does It Looks Like?

Chicken pox is a very common childhood virus infection. It is caused by varicella zoster virus and is extremely contagious. The virus spreads through droplets (exhaled air, coughing, sneezing) and contact with fluid from skin lesion (direct contact, sharing towel etc). The virus can survive outside human body in the environment for few hours.

Once you know that your child's schoolmate has chicken pox with skin rash, it is usually too late to avoid infection to your child unless there is no real close contact between them. This is because the infected child is able to spread the virus even 2 days before the rash appears.

If after contact with a chicken pox child for one week and your child still seems alright, it still does not mean that your child is not infected, as the incubation period for the virus is between 10-21 days. Usually the first symptoms to appear are rather non-specific such as mild fever, body ache, minor cough or flu symptoms. Most people only aware of the infection after the body rash appears.

Chicken pox rash is quite obvious and there are generally three stages. The first rash to appear is like a red dot, which will then progress to blisters that will eventually burst and become crusted (scabs). Typically the rash appears in crops, which means that at one time these three types of rash will appear together.

      Rash appears in crops

       Typical chicken pox rash

Chicken pox rash usually will last for 5 days. The infected child is considered non-contagious once all rashes have become scabs (dry). The infected child usually can return to school/nursery 1 week after the rash first appears.

There is no specific treatment for chicken pox other than symptomatic relief for fever/pain and itchiness. Antiviral is indicated only in some special circumstances such as in immuno-compromised child or when complication occurs.

Chicken pox can be prevented through vaccination. Young children can get the vaccine after 12 months old. For children more than 12 years old or adult, two doses given 6-10 weeks apart is recommended. 

Chest Pain: Is It Muscles?

Though chest pain can be very serious, most of the time it's not. One of the most common cause of chest pain is related to the musculoskeletal system.

Generally, chest pain involving the muscles, ligaments, bones & joints is usually localized to a specific area. It is also reproducible by applying pressure on the pain area. The pain is usually sharp and aggravated by moving the affected area such as when moving the body/arm or taking a deep breath (chest wall moves up and out).

There are a few reasons for musculoskeletal chest pain:

- muscle strain or ligament sprain : after strenuous exercise or work (carry heavy things etc), trauma, after heavy coughing, even after one night of improper sleeping posture etc.

- bone: fracture (obvious severe trauma), cancer (rare)

- ribs cartilages or joints (costochondritis): trauma, infection, unknown cause

Chest pain with musculoskeletal origin is usually harmless and will resolve by itself in a few days. Some pain-killer and anti-inflammatory medicine may help to relieve the pain.

Click here for clues on how to differentiate chest pain.

Chest Pain: How To Differentiate?

When we have chest pain, almost all of us will ask: Am I having a heart attack?

Of course there are lots of causes for chest pain. The pain around the chest can originate from any organs or structures beneath the chest wall such as:

- heart/aorta

- lungs/trachea

- esophagus/stomach

- muscle/bone/ligament/skin

- gallbladder/pancreas/liver

There are many types of chest pain, such as dull, sharp, tight, stabbing, pressing, burning etc. It is not easy to determine the cause of chest pain in most circumstances. However, doctors will ensure that the chest pain is at least not the type which is life-threatening and require immediate medical attention, such as heart attack, pneumothorax, aortic dissection, pulmonary embolism, acute pancreatitis etc.

When assessing chest pain, there are a few information which are important:

Location of chest pain:

- center of chest: heart, trachea, esophagus, musculoskeletal
- left or right of chest: lungs, musculoskeletal
- lower chest: stomach, gallbladder, pancreas, liver

The location of pain alone is not the only criteria to diagnose a chest pain. The pain of heart attack although commonly occurs in the center, but it may also be felt at the side of chest wall or the epigastric area (lower chest/upper abdomen).

Distribution of chest pain:

- radiate to the left chest/left arm/jaw: heart (angina, heart attack)
- radiate to the back: aorta (dissection), pancreas
- radiate to right shoulder: gallbladder

      Typical angina pain distribution

Nature of the pain:

- tight, gripping, pressing: heart (angina, heart attack)
- sharp, stabbing: lungs (pneumothrax, pulmonary embolism), aorta (dissection), musculoskeletal
- colicky: gallbladder (stone)
- burning: stomach (ulcer, gastritis), esophagus (reflux)

Onset of pain:

- sudden: heart (angina, heart attack), aorta (dissection), lungs (pneumothorax, pulmonary embolism), musculoskeletal
- gradual: any other causes

Duration of pain:

- comes and goes and infrequent and well in between: usually not so serious condition (musculoskeletal, gallstone, gastritis etc)
- continuous but mild: may indicate more serious condition (pneumonia, cancer etc)
- continuous and severe or worsening: may indicate more serious conditions that require medical attention immediately (heart attack, pneumothorax, pulmonary embolism, perforated gastric ulcer)

Pain aggravation:

- aggravated during inspiration: lungs (pleural), heart (pericardium), muscoloskeletal

- aggravated by food: stomach, gallbladder, esophagus

- aggravated by moving the arms: musculoskeletal

- aggravated by cough: lungs (pleural), heart (pericardium), muscoloskeletal

- aggravated by laying flat (supine): pericardium, pancreas

- aggravated by pressing: musculoskeletal, pleural

Severity of pain:

- Severity of pain is very subjective and varies from each individual. Generally the more severe the pain, the more serious the condition, such as in heart attack, aortic dissection, perforated gastric ulcer etc. However, some gastritis, gallstone, musculoskeletal pain may give rise to severe pain, even though they are not life-threatening.

Associated signs & symptoms:

This may be the most important information in determining the cause of chest pain.

- cough: lungs (infection, pneumothorax, cancer, embolism)

- shortness of breath: lungs (any cause), heart (heart attack)

- fever: infection, inflammation

- indigestion: stomach, esophagus, gallbladder

- nausea/vomiting: stomach, esophagus, heart (heart attack)

- palpitation: heart, lungs (pulmonary embolism)

The information above is not intended for self-diagnosing of chest pain. Please seek medical attention if you have a chest pain.

Chest Pain: Is It Lungs Problem?

Chest Pain: Is It Lungs?

Chest pain arising from lungs/respiratory tract usually will be accompanied by symptoms such as shortness of breath & cough.

Lungs infection (pneumonia/lung abscess)

In the case of lung infection, chest pain is usually not the main complaint. Initially fever and cough are the likely problems. When the infection gets worse, shortness of breath may occur as more lung volume is involved.

       Pneumonia: common lungs pathology but chest pain not common

Pneumothorax

This is a condition where air gets into the pleural cavity (space between the outer lungs and inner chest wall), causing the lung to collapse. This can occur during trauma/injury to the chest or spontaneously. 

In pneumothorax, shortness of breath is usually the first and most prominent symptom. In trauma case, of course the sufferer will have obvious chest injury and pain. In spontaneous case (without trauma), chest pain may be felt which may be worse when breathing in.

Pneumothorax is potentially fatal and sufferer should get immediate medical attention.

Pleuritis

Pleuritis is inflammation of the pleural which line the lungs and inner chest wall. Typically the pain is felt more when taking a deep breath in, as the pleural rub against the chest wall more during a deep breath.

       Pathology involving pleural will cause pleuritic pain (pain aggravated by breathing)

Lung cancer

Depends on the size and site of the cancer, lung cancer can give rise to chest pain but not very common. Other associated symptoms are cough, cough out blood, shortness of breath, loss of weight/appetite.

Pulmonary embolism

Pulmonary embolism occurs when a blood clot from the veins of lower part of body travel to the lungs and block the blood supply to a portion of the lung. This can cause sudden sharp chest pain, accompanied by shortness of breath. If the clot is large, it is potentially life-threatening.

Asthma

Obviously in asthma, sufferer will have shortness of breath and wheezing, and they may feel tightness in the chest as well.

Click here for clues on how to differentiate chest pain.

Chest Pain: Is It Heart Problem?

Chest Pain: Is It Heart?

Angina - precursor to "heart attack"

Angina is caused by narrowing of the coronary artery (which supply blood to heart muscle) which leads to temporary lack of blood/oxygen supply to the heart muscle when the demand for oxygen increases (during exertion). Thus, it is a condition of increased demand but limited supply of blood/oxygen.

     Narrowing of coronary artery causing angina

Typical angina is described as "pressing", "gripping", "tight" chest pain located at the center of chest which may radiate to the neck/jaw/left upper arm. This pain usually comes on exertion (physically or emotionally) and disappears during rest, and usually last <5min. This is referred as "stable angina".

If this is the first time you encounter this type of pain, you should see a doctor to have further evaluation on the pain. Doctor will usually arrange an appointment for exercise stress test / CT angiogram / percutaneous angiogram depends on your risk factors & preference.

If you are already known to have coronary heart disease, you can take the medicine under the tongue (nitroglycerin). If the pain is not relieved by the medicine, or last longer, or is more severe or more frequent than it used to be, you should go to hospital immediately for treatment as this may indicate more advance artery occlusion. This is referred as "unstable angina".

Myocardial infarction - true heart attack

Heart attack means that the already-narrowed coronary artery is suddenly blocked 100% (usually by a clot) causing heart muscle to die. In this case, more & more heart muscles are dying every second and that's why time is very crucial. The faster the sufferer gets treatment to open up the blockage, the higher the chance of survival and the better the outcome.

     Total occlusion of coronary artery causing heart attack

The nature of chest pain of heart attack is similar to angina but it is usually more severe and is commonly associated with other symptoms such as sweating, shortness of breath, dizziness, fainting, nausea etc. It can occur during exertion or even suddenly at rest (eg during sleep). However, sometimes the pain can be atypical and some elderly or diabetic patients may not feel the pain at all.

If you suspect yourself to have heart attack, please get someone else to drive you to nearest hospital as soon as possible, as every seconds count.

Aortic dissection

Another rare but important cause of chest pain is aortic dissection. It is important as it is life-threatening. In aortic dissection, the wall of aorta (which transport blood out of the heart to other body parts) is torn or seperated. Thus, it is usually described as severe "sharp" & "tearing" chest pain which may radiate to the back.

     Tearing of aortic wall

If the chest pain you experience is not the same as described above, it doesn't mean that it is not originating from the heart. When you are in doubt, always seek for medical attention.

There are other causes of chest pain related to the heart, such as infection or inflammation of the 3 layers of heart wall - endocarditis, myocarditis & pericarditis.

Click here for clues on how to differentiate chest pain.