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
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 An imaging study of the aorta
|
Pericarditis (inflammation of the membrane around the heart) | Potentially life threatening Sharp pain that
An abnormal heart sound, heard through a stethoscope | ECG Echocardiography Sometimes 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
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
Often in people who smoke, drink alcohol, or do both No warning signs‡ | A doctor's examination Sometimes endoscopy | |
Gastroesophageal reflux (GERD)§ | Typically, recurring, burning pain that
| A doctor's examination Sometimes endoscopy |
Gallbladder and bile duct disorders (biliary tract disease)§ | Recurring discomfort that
| Ultrasonography of the gallbladder Sometimes hepatobiliary scan (HIDA) |
Swallowing disorders in which there is abnormal movement (propulsion) of food through the esophagus§ | Pain that
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 angiography or nuclear scanning of the lungs Sometimes 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
Tenderness maximally in one spot on the chest No warning signs‡ | Only a doctor's examination |
Pain that is
| Only a doctor's examination | |
Sharp pain in a band around the chest and often the back 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 |
* 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
| ||
§ Unless otherwise described, causes are usually not dangerous, although they are uncomfortable. | ||
CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging. | ||