Chest Pain

Chest Pain

Heart Disease (Coronary Artery Disease) Slideshow

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Daniel Kulick, MD, FACC, FSCAI and Melissa Conrad Stöppler, MD

• Introduction
• What are the sources of chest pain?
• What are the symptoms and causes of chest pain?
• How is chest pain diagnosed?
• What is the philosophy of the approach to chest pain diagnosis?
• What is the diagnosis and treatment for cause of chest pain?
• Broken or bruised ribs
• Costochondritis
• Pleuritis or Pleurisy
• Pneumothorax
• Shingles
• Pneumonia
• Pulmonary embolism
• Angina and heart attack
• Pericarditis
• Aorta and aortic dissection
• Esophagus and reflux esophagitis
• Referred abdominal pain
• Chest Pain At A Glance
• Patient Discussions: Chest Pain - Cause

Introduction

Chest pain is one of the most common complaints that will bring a patient to the Emergency Department. Seeking immediate care may be lifesaving, and considerable public education has been undertaken to get patients to access medical care when chest pain strikes. While the patient may be worried about a heart attack, there are many other causes of pain in the chest that the healthcare provider will need to consider. Some diagnoses are life threatening, while others are less dangerous.

Deciding the cause of chest pain is sometimes very difficult and may require blood tests, x-rays, CT scans and other tests to sort out the diagnosis. Often though, a careful history taken by the healthcare provider may be all that is needed to find the answer.

What are the sources of chest pain?

The source of pain may arise from a variety of potential sources:

• the chest wall including the ribs, the muscles, and the skin;
  
  
• the back including the spine, the nerves, and the back muscles;
  
  
• the lung, the pleura (the lining of the lung) or the trachea;
  
  
• the heart including the pericardium (the sac that surrounds the heart);
  
  
• the aorta;
  
  
• the esophagus;
  
  
• the diaphragm, the flat muscle that separates the chest and abdominal cavities;
  
  
• referred pain from abdominal organs like the stomach, gallbladder, and pancreas.

While each source of chest pain may have a classic presentation of signs and symptoms, there is significant overlap among the symptoms of each condition, and the symptoms may also be affected by age, gender and race.

What are the causes of chest pain?

Pain can be caused by almost every structure in the chest. Different organs can produce different types of pain but unfortunately the pain is not specific to each cause. Each of the following causes is explained in detail in this article:

• Broken or bruised ribs
  
  
• Pleuritis or pleurisy
  
  
• Pneumothorax
  
  
• Shingles
  
  
• Pneumonia
  
  
• Pulmonary embolus
  
  
• Angina
  
  
• Heart attack (myocardial infarction)
  
  
• Pericarditis
  
  
• The aorta and aortic dissection
  
  
• The esophagus and reflux esophagitis
  
  
• Referred abdominal pain

Chest Pain - Cause

The MedicineNet physician editors ask:

What was the cause of your chest pain?

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