Chest pain

Chest pain is a common symptom experienced by people of all ages. It can arise from a variety of causes, ranging from relatively benign conditions to potentially life-threatening diseases. The underlying causes of chest pain can involve several different bodily systems, including the cardiovascular, respiratory, gastrointestinal, musculoskeletal, and nervous systems.

Depiction of a person suffering from chest pain

Heart Attack Chest Pain

Clinical Presentation

Chest pain can present in a variety of ways, depending on the underlying cause. It may be described as sharp, dull, burning, aching, tight, or crushing. The pain may be localized to one area of the chest, or it may radiate to the arms, neck, jaw, or back. Other accompanying symptoms can provide clues to the cause of the pain.

UOTW 71 - Ultrasound of the Week 4

Differential Diagnosis

• Due to the wide range of potential causes, the differential diagnosis of chest pain is broad and can be challenging. It is critical to first rule out life-threatening causes:
• Cardiovascular Causes: These include myocardial infarction (heart attack), angina, aortic dissection, and pericarditis.
• Respiratory Causes: Such as pneumonia, pulmonary embolism, and pleurisy.
• Gastrointestinal Causes: Examples are gastroesophageal reflux disease (GERD), esophageal spasm, and peptic ulcer disease.
• Musculoskeletal Causes: Including costochondritis and muscle strain.
• Psychogenic Causes: Such as panic disorder and somatoform disorder.

Evaluation

The evaluation of a patient with chest pain begins with a thorough history and physical examination. Specific diagnostic tests will depend on the suspected cause and may include an electrocardiogram (ECG), chest X-ray, blood tests, stress test, echocardiogram, or more specialized studies like computed tomography (CT) or magnetic resonance imaging (MRI).

Management

Management of chest pain is largely determined by its underlying cause. For example, myocardial infarction may require interventions such as thrombolysis or angioplasty, while GERD may be treated with lifestyle changes and medications to reduce stomach acid.

See Also

• Myocardial infarction
• Angina
• Gastroesophageal reflux disease
• Pulmonary embolism
• Panic disorder

References

• Kontos MC, Diercks DB, Kirk JD. (2010). Emergency Department and Office-Based Evaluation of Patients With Chest Pain. Mayo Clinic Proceedings, 85(3), 284-299.
• McConaghy JR, Oza RS. (2013). Outpatient Diagnosis of Acute Chest Pain in Adults. American Family Physician, 87(3), 177-182.
• Fruergaard P, Launbjerg J, Hesse B, Jørgensen F, Petri A, Eiken P, Aggestrup S, Elsborg L, Mellemgaard K. (1996). The diagnoses of patients admitted with acute chest pain but without myocardial infarction. European Heart Journal, 17(7), 1028-1034.

Chest pain Resources
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