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Chest pain may be described as sharp (possibly knifelike), dull, burning, or squeezing; it may be located in a specific spot on the chest (such as the chest wall) or may be difficult to locate, often feeling like a deep ache. The pain may be constant or intermittent, lasting seconds, minutes, or longer. It may be worsened by breathing, changes in body position, exertion, eating, or other factors.
Pleuritic pain is a sharp pain that is made worse by deep breathing and coughing. Keeping the chest wall still—for example, by holding the side that hurts and avoiding deep breathing or coughing—can reduce the pain. Usually, the site of the pain can be pinpointed, although it may move over time. Pain may occur in the part of the chest supplied by a nerve between the ribs (intercostal nerve). This pain runs from the spine across the back to the chest in a path roughly parallel to a rib, usually affecting an area no wider than two or three ribs.
Causes
Chest pain may arise from structures in the respiratory system, including the pleura (the two-layered membrane covering the lungs). Chest pain can also arise from structures not related to the respiratory system, such as the chest wall, heart, major blood vessels, or esophagus. Some disorders of the heart and major blood vessels are serious; a person may need immediate testing and treatment.
Pleuritic pain often results from inflammation of the pleura (pleurisy). There are many causes of pleuritic pain, including viral and bacterial infections, cancer, and inflammation from disorders that can affect many organs, such as rheumatoid arthritis and systemic lupus erythematosus. Blood clots can travel through the bloodstream to the lungs (pulmonary embolism (see Pulmonary Embolism (PE): Pulmonary Embolism)), lodge in the pulmonary arteries, and cause pleuritic chest pain. Air in the chest cavity (pneumothorax) and inflammation of the membrane surrounding the heart (pericarditis) can also cause chest pain that worsens during deep breathing. Pleural effusion, a fluid buildup in the space between the two layers of pleura (see Pleural Disorders: Pleural Effusion), may produce pleuritic pain at first, but the pain may subside as accumulating fluid separates the two layers.
Pain arising from other lung disorders (such as a lung abscess or tumor) is usually more difficult to describe than pleuritic pain. The pain is often described as a vague, deep-seated ache in the chest. Almost any disorder that damages the lungs or airways can cause such pain.
Pain originating in the chest wall may worsen with deep breathing or coughing and often is confined to one area in the chest wall, which also feels sore when pressed. The most common causes are chest wall injuries, such as broken ribs and torn or injured muscles located between the ribs (intercostal muscles). Even hard coughing can injure these muscles, causing pain for days or weeks. Pain along the area supplied by an intercostal nerve occurs if the nerve is irritated by a tumor or affected by shingles, which is caused by the varicella-zoster virus. In shingles, pain may occur before the tell-tale rash appears.
Evaluation and Treatment
Characteristics of the pain that a person describes provide clues to help doctors determine the cause. A chest x-ray is usually done. It often reveals the cause of chest pain, particularly pain caused by respiratory system problems. If serious disorders of the heart or major blood vessels are suspected, tests that help diagnose them are done, such as an electrocardiogram (ECG) or blood tests. Treatment is directed at the underlying disorder. Until the underlying disorder is controlled, drugs can relieve pain.
Last full review/revision November 2006 by James H. Fisher, MD
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