How does malnutrition cause chest pain?

How Malnutrition Causes Chest Pain

Malnutrition can cause chest pain through multiple mechanisms including respiratory muscle weakness, cardiac dysfunction, gastrointestinal disorders, and electrolyte imbalances. 1

Musculoskeletal Mechanisms

• Malnutrition leads to respiratory muscle weakness and susceptibility to diaphragmatic fatigue, which can manifest as chest pain due to increased work of breathing 1
• Poor nutrition causes decreased caloric intake and excessive caloric expenditure, leading to delayed lung and chest wall growth, which can result in chest discomfort 1
• Respiratory muscle weakness from malnutrition can lead to chronic respiratory failure, which may present with chest pain 1

Cardiac Mechanisms

• Malnutrition is associated with heart failure, which can cause chest pain and is a common complication in severely malnourished patients 1
• Cardiac cachexia (severe malnutrition associated with heart disease) is characterized by non-intentional weight loss >7.5% and is associated with abnormal neuroendocrine and immunologic function that can manifest as chest pain 1
• Decreased cardiac output from malnutrition-related heart dysfunction causes decreased effective renal blood flow, leading to fluid retention that can worsen chest pain 1

Gastrointestinal Mechanisms

• Malnutrition can exacerbate or be associated with gastroesophageal reflux disease, which is a common cause of non-cardiac chest pain that can mimic myocardial ischemia 1
• Esophageal disorders related to malnutrition can present as squeezing retrosternal pain or spasm, often accompanied by dysphagia 1
• Gastroesophageal reflux-related chest pain may be described as squeezing or burning, with duration from minutes to hours, often occurring after meals or at night 1

Metabolic and Hematologic Mechanisms

• Severe vitamin B12 deficiency, which can result from malnutrition or malabsorption, can lead to hemolytic anemia that presents with chest pain 2
• Malnutrition can cause electrolyte imbalances that affect cardiac function and may manifest as chest pain 3
• Chronic hypoxemia resulting from malnutrition-related respiratory muscle weakness can divert calories from growth and further worsen nutritional status, creating a vicious cycle 1

Inflammatory Mechanisms

• Chronic disease-related malnutrition with inflammation (cachexia) involves elevated inflammatory markers that can contribute to chest pain through multiple pathways 1
• The combined action of pro-inflammatory cytokines, increased stress hormones, and insulin resistance in malnourished patients can accelerate catabolism and worsen symptoms including chest pain 1

Clinical Implications

• When evaluating chest pain in malnourished patients, clinicians should consider both cardiac and non-cardiac causes, as approximately 10-20% of outpatients with chest pain have a gastrointestinal cause 1
• Nutritional assessment is mandatory to recognize malnutrition early and initiate timely nutritional therapy, which can reduce complications including chest pain 4
• Screening for micro- and macro-nutrient deficiencies should be performed in malnourished patients presenting with chest pain 1

Prevention and Management

• Optimizing nutritional status before procedures can reduce postoperative morbidity, including chest pain 1
• Nutritional therapy has been shown in high-quality randomized trials to reduce morbidity and complications associated with malnutrition 5
• Addressing both the underlying causes of malnutrition and providing direct nutritional interventions are essential for resolving malnutrition-related chest pain 6