Merck Manual

Please confirm that you are not located inside the Russian Federation

Some Causes and Features of Chest Pain

Some Causes and Features of Chest Pain

Causes

Common Features*

Tests†

Heart disorders

Heart attack (myocardial infarction) or unstable angina

Immediately life threatening

Sudden, crushing pain that

  • Spreads to the jaw or arm

  • May be constant or come and go

Sometimes shortness of breath or nausea

Pain that occurs during exertion and is relieved by rest (angina pectoris)

Certain abnormal heart sounds, heard through a stethoscope

Often warning signs‡

ECG, done several times over a period of time

Blood tests to measure substances that indicate heart damage (cardiac markers)

If ECG and cardiac marker levels are normal, often CT of heart arteries or a stress test

If ECG or cardiac marker levels are abnormal, heart catheterization

Thoracic aortic dissection (a tear in the wall of the part of aorta in the chest)

Immediately life threatening

Sudden, tearing pain that spreads to or starts in the middle of the back

Sometimes light-headedness, stroke, or pain, coldness, or numbness in a leg (indicating inadequate blood flow to the leg)

Sometimes a pulse or blood pressure in one limb that differs from that in the other limb

Usually in people who are over 55 and have a history of high blood pressure

Warning signs

Chest x-ray

CT of the aorta

Transesophageal echocardiography (ultrasonography of the heart with the ultrasound device passed down the throat)

Pericarditis (inflammation of the membrane around the heart)

Potentially life threatening

Sharp pain that

  • Is constant or comes and goes

  • Is often worsened by breathing, swallowing food, or lying on the back

  • Is relieved by leaning forward

An abnormal heart sound, heard through a stethoscope

ECG

Echocardiography

Blood tests to measure substances that indicate heart damage (cardiac markers)

MRI

Digestive tract disorders

Immediately life threatening

Sudden, severe pain immediately after vomiting or after a medical procedure involving the esophagus (such as endoscopy of the esophagus and stomach or transesophageal echocardiography)

Several warning signs‡

Chest x-ray

X-rays of the esophagus taken after the person swallows water-soluble contrast (esophagography)

Pancreatitis (inflammation of the pancreas)

Potentially life threatening

Severe, constant pain that

  • Occurs in the upper middle of the abdomen or in the lower chest

  • Is often worse when lying flat

  • Is relieved by leaning forward

Vomiting

Upper abdominal tenderness

Sometimes shock

Often in people who abuse alcohol or who have gallstones

Blood tests to measure an enzyme (lipase) produced by the pancreas

Sometimes CT of the abdomen

Recurring, vague discomfort that

  • Occurs in the upper middle of the abdomen or lower chest

  • Is relieved by antacids and sometimes by food

Often in people who smoke, drink alcohol, or do both

No warning signs‡

A doctor's examination

Sometimes endoscopy

Recurring, burning pain that

  • Spreads from the upper middle of the abdomen to the throat

  • Is worsened by bending over or lying down

  • Is relieved by antacids

A doctor's examination

Sometimes endoscopy

Gallbladder and bile duct disorders (biliary tract disease)§

Recurring discomfort that

  • Occurs in the upper right of the abdomen or the lower middle of the chest

  • Occurs after meals (but not after exertion)

Ultrasonography of the gallbladder

Sometimes hepatobiliary scan (HIDA)

Swallowing disorders in which there is abnormal movement (propulsion) of food through the esophagus

Pain that

  • Has developed gradually over a long period of time

  • May or may not occur during swallowing

Usually difficulty swallowing

Sometimes x-rays of the upper digestive tract after barium is given by mouth (barium swallow)

A test to determine whether contractions in the digestive tract are normal (esophageal manometry)

Lung disorders

Pulmonary embolism (blockage of an artery in the lungs by a blood clot)

Immediately life threatening

Often sharp pain when breathing in, shortness of breath, rapid breathing, and a rapid heart rate

Sometimes mild fever, coughing up blood, or shock

More likely in people with risk factors for pulmonary embolism (such as previous blood clots, recent surgery especially surgery on the legs, prolonged bed rest, a cast or splint on a leg, older age, smoking, or cancer)

CT or nuclear scanning of the lungs

A blood test to detect blood clots (D-dimer test)

Tension pneumothorax (a collapsed lung with a high-pressure buildup of air in the chest)

Immediately life threatening

Significant shortness of breath

Low blood pressure, swollen neck veins, and weak breath sounds on one side, heard through a stethoscope

Typically occurs only after a severe chest injury

Usually only a doctor's examination

Sometimes chest x-ray

Potentially life threatening

Fever, chills, cough, and usually yellow or green phlegm

Often shortness of breath

Sometimes pain when breathing in

A rapid heart rate and congested lungs, detected during the examination

Chest x-ray

Pneumothorax (a collapsed lung)

Potentially life threatening

Sudden, sharp pain, usually on one side of the chest

Sometimes shortness of breath

Sometimes weak breath sounds on one side, heard through a stethoscope

Chest x-ray

Pleuritis (inflammation of the membrane around the lung)§

Sharp pain when breathing

Usually in people who have recently had pneumonia or a viral respiratory infection

Sometimes cough

No warning signs‡

Usually only a doctor's examination

Other disorders

Pain in the chest wall,§ including the muscles, ligaments, nerves, and ribs (musculoskeletal chest wall pain)

Pain that

  • Is typically persistent (lasting days or longer)

  • Is worsened by movement and/or breathing

  • May have no apparent cause or may result from coughing or overuse

Tenderness in one spot on the chest

No warning signs‡

Only a doctor's examination

Pain that is

  • Nearly constant

  • Affects widespread areas of the body

  • Is usually accompanied by fatigue and poor sleep quality

Only a doctor's examination

Sharp pain in a band around the middle of the chest but only on one side

A rash of many small blisters. sometimes filled with pus, in the painful area and sometimes appearing only after the pain

Only a doctor's examination

Cancers of the chest or chest wall

Sometimes pain that is worse when breathing in

Sometimes chronic cough, smoking history, weight loss, swelling of lymph nodes in the neck

Chest x-ray

Chest CT

Sometimes a bone scan

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† For most people with chest pain, the oxygen level in blood is measured with a sensor placed on a finger (pulse oximetry), ECG is done, and a chest x-ray is taken.

‡ Warning signs include

  • Abnormal vital signs (an abnormally slow or fast heart rate, rapid breathing, and abnormally low blood pressure)

  • Signs of decreased blood flow (such as confusion, pale or gray skin color, and excessive sweating)

  • Shortness of breath

  • Abnormal breath sounds or pulses

  • New heart murmurs

§ Unless otherwise described, causes are usually not dangerous, although they are uncomfortable.

CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging.