Table: Some Causes and Features of Chest Pain - Merck Manuals Consumer Version

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
Esophageal rupture	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
Peptic ulcer§	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
Gastroesophageal reflux (GERD)§	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
Pneumonia	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
Fibromyalgia	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
Shingles^§	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.

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Some Causes and Features of Chest Pain