Chest pain is one of the most common symptoms that bring an individual to the emergency department. Seeking immediate care may be lifesaving. Considerable public education has been undertaken to get patients to seek medical care when chest pain strikes. You may be worried that you have a heart attack, but there are many other causes of pain in the chest that the doctor will consider. Some diagnoses of chest pain 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 doctor may be all that is needed. There are many causes of chest pain. While many are not severe, it may be difficult to distinguish a heart attack, pulmonary embolus, or aortic dissection from another diagnosis that is not life-threatening, like heartburn. For that reason, individuals are routinely advised to seek medical evaluation for most types of chest pain.
Pain can be caused by almost every structure in the chest. Different organs can produce different pain types; unfortunately, the pain is not specific to each cause. Many reasons can cause chest pain, for example:
• 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
While each cause of chest pain has classic symptoms and signs, there are enough variations in symptoms that may take specific testing to reach a diagnosis. Tests to diagnose chest pain will depend on your current health and the results of any tests or procedures.
Treatment for chest pain depends on the cause. Always seek medical care if you are having chest pain.
Chest pain can be associated with dizziness, lightheadedness, shortness of breath, or stabbing or burning sensations.
Other signs and symptoms that occur with chest pain include chest (heart) pain and chest discomfort, including pressure, squeezing, heaviness, or burning. Sometimes you may feel like you are choking or short of breath. People who have had severe chest pain describe it as discomfort that ranges from sharp to dull and usually is located in the jaw, neck, shoulders, upper abdomen, and arms.
Signs like anxiety and other conditions, exertion, eating, exposure to cold, or emotional stress can cause tightness of the chest.
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
• 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. Still, 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.
Coronary heart disease
• High blood pressure
• High cholesterol
• Family history
Pulmonary embolus (blood clot to the lung)
• Prolonged inactivities such as bed rest, long car or airplane trips
• Recent surgery
• Birth control pill use (significantly if the patient smokes cigarettes)
• High blood pressure
• Marfan syndrome
• Ehlers-Danlos syndrome
• Polycystic kidney disease
• Cocaine use
The key to diagnosis is the patient’s medical history. Learning about the nature of the pain will give the health care professional direction about proper diagnoses to consider and reasonable to exclude. Understanding the quality and quantity of the pain, its associated symptoms, and the patient’s risk factors for a specific disease can help the doctor assess each potential cause’s probability and make decisions about what diagnoses should be considered and which ones can be discarded.
Differential diagnosis is a thought process that healthcare professionals use to consider and then eliminate potential causes of an illness. As more information is gathered, the likely diagnosis list is narrowed until the final answer is achieved from either history, physical examination, or testing. Moreover, the patient’s response to therapeutic interventions can expand or narrow the differential diagnosis list. In patients with chest pain, many possible conditions may be present. The health care professional will want first to consider those that are life-threatening. Using laboratory and X-ray tests may not be necessary to exclude potentially lethal diseases like heart attack, pulmonary embolus, or aortic dissection when clinical skills and judgment are employed.
The patient may be asked various questions to help the health care professional understand the quality and quantity of the pain. Patients use different words to describe the pain. The health care professional must get an accurate impression of the situation. The questions may also be asked in different ways.
The person may be asked to explain their answer because sometimes words mean something different to other people. If the person says, “they aren’t having chest pain,” they neglect to tell the doctor that they feel “chest pressure.” People may describe the pain as sharp, but they mean intense, while the doctor may think that sharp equals are stabbing. The doctor’s understanding of the quality of pain is an essential first step in making the diagnosis.
There is a distinct difference between the qualities of pain. The doctor needs to know the type of pain and how much pain the person is experiencing.
Questions the doctor may ask about chest pain
1. When did the pain start?
2. What is the quality of the pain?
3. How long does the pain last?
4. Does the pain come and go?
5. What makes the pain better?
6. What makes the pain worse?
7. Does the pain radiate somewhere (move to another area of the body)?
8. Has there been any preceding illness?
9. Has there been any trauma?
10. Have there been similar episodes of pain in the past?
11. Is the pain different from that of a previous condition experienced, or is it similar?
Questions about the associated symptoms
1. Is there shortness of breath?
2. Fever or chills?
4. Nausea or vomiting?
By reading this website, you acknowledge that you are responsible for your own health decisions. The information throughout this medical website is not intended to be taken as medical advice. The information provided is intended for general information regarding Pain Management symptoms and services.
If you are interested in finding out more, avoid worrisome self-diagnosis, please contact our Pain Management specialist for a personal consultation. No information on this site should be used to diagnose, treat, prevent, or cure any disease or condition.