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Chest pain

Definition

Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.

Alternative Names

Chest tightness; Chest pressure; Chest discomfort

Considerations

Many people with chest pain fear a heart attack. However, there are many possible causes of chest pain. Some causes are not dangerous to your health, while other causes are serious and even life-threatening.

Any organ or tissue in your chest can be the source of pain, including your heart, lungs, esophagus, muscles, ribs, tendons, or nerves. Pain may also spread to the chest from the neck, abdomen, and back.

Causes

Heart problems that can cause chest pain:

• Angina is a type of heart-related chest pain. This pain occurs because your heart is not getting enough blood and oxygen. The most common symptom is chest pain that occurs behind the breast bone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the arm, shoulder, jaw, or back.
• Aortic dissection (tearing of the aorta wall) causes sudden, severe pain in the chest and upper back.
• Heart attack pain can be similar to the pain of unstable angina, but more severe.
• Inflammation or infection in the tissue around the heart (pericarditis) causes pain in the center part of the chest.

Lung problems that can cause chest pain:

• A blood clot in the lung (pulmonary embolism), collapse of a small area of the lung (pneumothorax), or inflammation of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.
• Asthma generally also causes shortness of breath, wheezing, or coughing.
• Pneumonia causes chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough.

Other causes of chest pain:

• Anxiety and rapid breathing
• Inflammation where the ribs join the breast bone or sternum (costochondritis)
• Shingles (inflammation/infection of the nerve that causes sharp, tingling pain on one side that stretches from the chest to the back)
• Strain or inflammation of the muscles and tendons between the ribs

Chest pain can also be related to the following digestive system problems:

• Achalasia
• Esophageal spasms (abnormal contractions of the muscles in the tube that carries food from the mouth to the stomach)
• Gallbladder (pain often gets worse after a meal, especially a fatty meal)
• Heartburn or gastroesophageal reflux (GERD)
• Pancreatitis (aching pain in the upper abdomen and back)
• Stomach ulcer or gastritis (burning pain occurs if your stomach is empty and feels better when you eat food)

In children, most chest pain is not caused by the heart.

Home Care

For many causes of chest pain, it is best to check with your doctor or nurse before treating yourself at home.

If injury, overuse, or coughing have caused muscle strain, your chest wall is often tender or painful when you press a finger at the location of the pain. This can often be treated at home. Try acetaminophen or ibuprofen, ice, heat, and rest.

If you know you have asthma or angina, follow your doctor's instructions and take your medications regularly to avoid flare-ups.

See: Heartburn for information about treatment at home.

When to Contact a Medical Professional

Call 911 if:

• You have sudden crushing, squeezing, tightening, or pressure in your chest.
• Pain radiates to your jaw, left arm, or between your shoulder blades.
• You have nausea, dizziness, sweating, a racing heart, or shortness of breath.
• You know you have angina and your chest discomfort is suddenly more intense, brought on by lighter activity, or lasts longer than usual.
• Your angina symptoms occur at rest.
• You have sudden sharp chest pain with shortness of breath, especially after a long trip, a stretch of bedrest (for example, following an operation), or other lack of movement that can lead to a blood clot in your leg.

Know that your risk of heart attack is greater if you have a family history of heart disease, you smoke, use cocaine, are overweight, or you have high cholesterol, high blood pressure, or diabetes.

Call your doctor if:

• You have a fever or a cough that produces yellow-green phlegm.
• You have chest pain that is severe and does not go away.
• You are having problems swallowing.
• Chest wall pain persists for longer than 3 to 5 days.

What to Expect at Your Office Visit

Emergency measures will be taken, if necessary. Hospitalization will be required in difficult or serious cases or when the cause of the pain is unclear.

The doctor will perform a physical examination and monitor your vital signs (temperature, pulse, rate of breathing, blood pressure). The physical examination will focus on the chest wall, lungs, and heart. Your doctor may ask questions like the following:

• Is the pain between the shoulder blades? Under the breast bone? Does the pain change location? Is it on one side only?
• How would you describe the pain? (Severe, tearing or ripping, sharp, stabbing, burning, squeezing, constricting, tight, pressure-like, crushing, aching, dull, heavy)
• Does it come on suddenly? Does the pain occur at the same time each day?
• Is the pain getting worse? How long does the pain last?
• Does the pain go from your chest into your shoulder, arm, neck, jaw, or back?
• Is the pain worse when you are breathing deeply, coughing, eating, or bending?
• Is the pain worse when you are exercising? Is it better after you rest? Is it completely relieved or just less pain?
• Is the pain better after you take nitroglycerin medication? After you drink milk or take antacids? After belching?
• What other symptoms are also present?

Diagnostic tests that may be performed include:

• Blood tests (such as LDH, LDH isoenzymes, CPK, CPK isoenzymes, troponin, CBC, and blood differential)
• Cardiac catheterization
• ECG
• Echocardiogram
• Exercise ECG
• Lung scan
• X-rays of the chest

More complex tests may be required, depending on the difficulty of diagnosis or the suspected cause of the chest pain.

Prevention

Make healthy lifestyle choices to prevent chest pain from heart disease:

• Achieve and maintain normal weight.
• Control high blood pressure, high cholesterol, and diabetes.
• Avoid cigarette smoking and secondhand smoke.
• Eat a diet low in saturated and hydrogenated fats and cholesterol, and high in complex carbohydrates, fiber, fruits, and vegetables.
• Get at least 30 minutes of moderate intensity exercise on most days of the week.
• Reduce stress.

References

Brown JE, Hamilton GC. Chest Pain. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 18.

Anderson JL, Adams CD, Antman EM, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). Circulation. 2007;116:803-877.

Cayley, Jr WE. Diagnosing the cause of chest pain. Am Fam Physician. 2005;72:2012-2021.

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