CHEST PAIN CAUSES

 

    Chest pain is a common complaint but is a diagnostic challenge. It has a wide variety of causes. This is how I classify chest pain broadly

 

Serious causes for chest pain 

     These are emergencies and one should not delay seeking medical care. These conditions
include:

A. Heart related causes for chest pain 

1. Heart Attack 

    This is of course most suspected cause for a chest pain. Though a serious condition, timely identification and treatment improve prognosis. An ECG should be done immediately. Emergency transfer to a hospital equipped with Cath lab is recommended

 

2. Aortic dissection 

     Tough it is very rare when compared to heart attack but can be more lethal than heart attack. A tear occurs in the major artery of the body called aorta.

 

 

 

3. Cardiac tamponade 

      Fluid around the heart (called as cardiac tamponade) makes heart not to fill properly.

 

B. Lungs related causes for chest pain 

1. Pulmonary embolism 

    Clot in the lung that migrates from legs causes this emergency

 

 

 

2. Tension pneumothorax 

     Rupture of lung tissue leads to leakage of air around lung, there by not allowing lung to expand effectively

 

 

C. Digestive system related for chest pain 

1. Esophageal rupture, perforation 

    Rigorous straining or vomiting causes food pipe to tear or rupture

 

 

Non-emergency causes of chest pain

A. Cardiac conditions that cause stable chest pain

1. Stable myocardial ischemia 

    Heart pain is considered stable when provoked by exercise, stress, emotion or sex.

2. Pericarditis

    Redness and edema of the pericardial sac (sac that surrounds heart) is called pericarditis. It is often caused by infection, drugs
, kidney failure, and cancer.

 

B. Lung conditions that cause stable chest pain

1. Pneumonia 

     Infection in lung tissue causes chest pain apart from fever and cough.

 

 

2. Malignancy 

    lung cancer may cause chest pain, along with cough, blood in sputum, and weight loss.

 

 

3. Pleuritis 

     Redness and edema of the lung pleura (sac that surrounds lung).  Causes include   drugs and infections

 

 

 

 

C. Gastrointestinal conditions that cause stable chest pain

1. GERD 

      Reflux of stomach content to food pipe causes redness and edema which causes chest pain

 

 

2. Peptic ulcer disease 

    Ulcer in the stomach causes chest pain along with abdominal pain

 

 

 

3. Esophagitis 

     Redness and edema of food pipe is called esophagitis. It can be caused by drugs, infections, or radiation injury.

 

 

D. Musculoskeletal  musculoskeletal pain

 

    Redness and edema of rib cage or chest muscles or various joints of chest cause musculoskeletal type of chest pain

Various causes are rheumatoid arthritis, Rib fractures, chest injury 

 

 

 

E. Psychiatric  

1. Panic attack/disorder 

     Panic attacks is an episode of intense fear that begin abruptly and last for several minutes to an hour. One in four persons with a panic attack will have chest pain

 

 

 

F. Referred pain 

     Chest wall pain may be referred from painful disorders in other areas of body like neck or abdomen.  Referred pain can come from abdominal organs, cervical disc disease. Acute cholecystitis and pancreatitis may have referred pain that involves the chest. These can sometimes be very serious and need emergency care.