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Pain due to a disorder of the heart, lungs, esophagus, or large blood vessels of the trunk is usually felt in the chest, although it can seem to be located anywhere between the upper abdomen and the jaw, including the arms or shoulders. The discomfort may be described as pressure, gas, burning, aching, or sometimes sharp pain.
Causes
Chest pain has many causes. Immediately life-threatening causes include a heart attack, separation of the layers of the aorta's wall (aortic dissection), rupture of the esophagus, a blood clot in the lungs (pulmonary embolism), and a type of collapsed lung in which pressure builds up enough to obstruct blood flow returning to the heart (tension pneumothorax). Less immediately dangerous causes include an inadequate blood supply to the heart (ischemia), inflammation of the sac that envelops the heart (pericarditis), pneumonia, inflammation of the pancreas (pancreatitis), and certain cancers. Uncomfortable but rarely dangerous causes include acid reflux in the esophagus, peptic ulcer, inflammation of rib cartilage (costochondritis) or of the membranes covering the lungs (pleuritis), strained chest muscles, and a gallbladder disorder. In some people, the valve between the left atrium and left ventricle (mitral valve) bulges back into the left atrium when the left ventricle contracts. This disorder, called mitral valve prolapse, sometimes causes brief episodes of stabbing or needle-like pain.
Evaluation
Sometimes the symptoms suggest a cause to the doctor. For example, tightness or a squeezing sensation in the chest that occurs during physical activity and that is relieved by a few minutes of rest suggests angina, which results from an inadequate blood supply to the heart. A sharp pain that worsens when the person lies down or breathes deeply, decreases when the person sits up and leans forward, and is not related to physical activity suggests pericarditis. Pain increased by inhaling deeply can also be caused by pleuritis. A sudden sharp, excruciating pain in the back of the neck, between the shoulder blades, down the back, or in the abdomen that begins fairly quickly may be due to an aortic dissection.
Symptoms due to dangerous and not dangerous chest disorders overlap and vary greatly. Consequently, tests are usually done if people have chest pain. Evaluation and testing are usually done in the hospital or emergency department if a dangerous cause is suspected. The tests are chosen based on the person's physical examination, age, overall health, other symptoms, and risk factors. But most often, an electrocardiogram (ECG), chest x-ray, and measurement of oxygen levels with a small sensor placed over a finger (pulse oximetry) are done. If the doctor suspects a heart attack, blood tests to measure levels of heart muscle enzymes and proteins may be done several times. High levels of these enzymes indicate damage to heart muscle. If angina is suspected, exercise stress testing may be done (see Diagnosis of Heart and Blood Vessel Disorders: Exercise Stress Testing).
Last full review/revision April 2006 by Paul H. Tanser, MD
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