• There are many causes of chest pain, and while many are not serious, it may be difficult to distinguish a heart attack, pulmonary embolus or aortic dissection, from another diagnosis that is not life-threatening. For that reason, patients are routinely advised to seek medical evaluation for most types of chest pain.
• While each cause of chest pain has a classic presentation, there are enough variations that it may take specific testing to reach a diagnosis. These tests will depend on the patient’s presentation and the health care professional’s index of suspicion as to what the diagnosis might be.
• Treatment for chest pain depends upon the cause.
• It is best to be safe. Always seek medical care for the assessment of chest pain.
Chest pain is one of the most common complaints that will bring a patient to the emergency department. Seeking immediate care may be lifesaving, and considerable public education has been undertaken to get patients to seek medical care when chest pain strikes. While the patient may be worried about a heart attack, there are many other causes of pain in the chest that the health care professional will need to consider. Some diagnoses are life-threatening, while others are less dangerous.
Deciding the cause of chest pain is sometimes very difficult and may require blood tests, X-rays, CT scans and other tests to sort out the diagnosis. Often though, a careful history taken by the health care professional may be all that is needed.
The following anatomic locations can all be potential sources of chest pain:
• the chest wall including the ribs, the muscles, and the skin;
• the back including the spine, the nerves, and the back muscles;
• the lung, the pleura (the lining of the lung), or the trachea;
• the heart including the pericardium (the sac that surrounds the heart);
• the aorta;
• the esophagus;
• the diaphragm, the flat muscle that separates the chest and abdominal cavities; and
• referred pain from the abdominal cavity including organs like the stomach, gallbladder, and pancreas, as well as irritation from the underside of the diaphragm due to infection, bleeding or other types of fluid.
There may be classic presentations of signs and symptoms for many diseases but they can also present atypically and there may also be significant overlap among the symptoms of each condition. Age, gender, and race can affect presentation and the health care professional must consider many variables before reaching a diagnosis.
Pain can be caused by almost every structure in the chest. Different organs can produce different types of pain and unfortunately the pain is not specific to each cause. Each of the following causes is reviewed in detail in this article:
• Broken or bruised ribs
• Pleuritis or pleurisy
• Pulmonary embolus
• Heart attack (myocardial infarction)
• The aorta and aortic dissection
• The esophagus and reflux esophagitis
• Referred abdominal pain