Causes of chest pain range from non-serious to life-threatening. In adults the most common causes of chest pain include:
gastrointestinal (42%),
coronary artery disease (31%),
musculoskeletal (28%),
pericarditis (4%) and
pulmonary embolism (2%).
Psychogenic causes of chest pain can include
panic attacks; however, this is a diagnosis of exclusion. Chest pain in children can also have congenital causes.
Cardiovascular •
Acute coronary syndrome •
Stable or
unstable angina •
Myocardial infarction ("heart attack"): People typically present with pressure or squeezing sensation over the chest in addition to sweating, nausea, vomiting, and weakness. •
Pericarditis: This condition can be the result of viral infection such as
coxsackie virus and
echovirus, tuberculosis, autoimmune disease, uremia, and after myocardial infarction (
Dressler syndrome). The chest pain is often
pleuritic in nature (associated with respiration) which is aggravated when lying down and relieved on sitting forward, sometimes, accompanied by fever. On auscultation,
pericardial friction rub can be heard. •
Cardiac tamponade: Cardiac tamponade occurs due to fluid accumulation in the pericardial space and typically presents with chest pain often accompanied by symptoms like dyspnea, hypotension, and pulsus paradoxus. Clinical signs include Beck's triad—hypotension, jugular venous distension, and muffled heart sounds. •
Arrhythmia:
Atrial fibrillation and several other arrhythmias can cause chest pain. •
Myocarditis: Myocarditis often affects young men under 45, presenting with symptoms such as chest pain, rapid heartbeat, palpitations, difficulty breathing, and early heart failure signs. Approximately one-third experience sharp, squeezing chest pain, while nonspecific symptoms like fever, fatigue, and muscle aches may also occur. Common causes range from viral infections like Coxsackie and
adenovirus to bacterial, fungal, chemical exposures, and autoimmune conditions such as lupus and rheumatoid arthritis. •
Mitral valve prolapse syndrome: Those affected are usually slim females presented with chest pain which is sharp in quality, localized at the apex, and relieved when lying down. Other symptoms include: shortness of breath, fatigue, and palpitations. On auscultation, midsystolic click followed by late systolic murmur can be heard, louder when person is in standing position. •
Aortic aneurysm: Aortic aneurysms, particularly when they rupture or dissect, cause sudden, severe chest or back pain often described as tearing or ripping. Thoracic aortic aneurysms are usually asymptomatic until they expand or rupture at which point they often have a >94% mortality rate
. Respiratory •
Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and
Bronchospasm. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. Chest pain usually happens during a strenuous activity or heavy exercise. •
Bronchitis: Bronchitis occurs due to inflammation of the bronchial tubes, often triggered by viral infections or irritants like smoke, leading to excessive mucus production and airway obstruction. Common symptoms include a productive cough, wheezing, mild chest discomfort, and fatigue. •
Pulmonary embolism: Common signs and symptoms are shortness of breath, pleuritic chest pain,
blood in sputum during cough, and lower limb swelling. Risk factors includes: recent surgery, cancer, and bedridden state. Embolus source usually comes from
venous thromboembolism. •
Pneumonia: Pneumonia arises from infections that cause inflammation and fluid accumulation in the alveoli of the lungs, with bacterial pathogens like
Streptococcus pneumoniae being common culprits. Clinically, it manifests as fever, persistent cough, difficulty breathing, and pleuritic chest pain that worsens with deep breaths. •
Hemothorax: A hemothorax occurs from accumulation of blood in the pleural cavity, commonly due to trauma, vascular injury, or coagulopathies, which can disrupt lung expansion and oxygenation. Key symptoms include sharp chest pain, difficulty breathing, low blood pressure in severe cases, and diminished breath sounds accompanied by dullness to
percussion over the affected area. •
Pneumothorax: Those who are at a higher risk of developing pneumothorax are tall, slim male smokers who have had underlying lung diseases such as
emphysema. Those affected can have a sharp chest pain which radiates to the shoulder of the same side. Physical examination revealed absent breath sounds and hyperresonance on the affected side of the chest. •
Pleurisy: (Pleuritic Chest Pain) The pain is sharp, localized, and is frequently exacerbated with coughing or inspiration. It can be attributed to various etiologies including pulmonary embolism, pneumothorax, pericarditis, and viral pleurisy. •
Tracheitis: Tracheitis, usually a bacterial driven inflammation of the trachea, which often narrows the airway. It can present as stridor and may cause respiratory distress symptoms like tachypnea, cyanosis, and hoarseness. Clinical symptoms include a dry, painful cough that worsens at night and may progress to a productive cough, fever, and retrosternal chest pain due to irritation of tracheal mucosa. •
Lung cancer: Hemoptysis, cough, dyspnea, chest pain, and other constitutional symptoms are commonly seen in lung cancer
Gastrointestinal •
Gastroesophageal reflux disease: The pain is aggravated when lying down or after meals. Affected individuals may describe this as a
heartburn. Besides, they may also complain of tasting bitter contents from the stomach. •
Hiatus hernia: A hiatal hernia occurs when a portion of the stomach pushes upward through the diaphragm into the chest cavity. While gastroesophageal reflux, presenting as heartburn and regurgitation, is the hallmark symptom, other manifestations such as dysphagia, epigastric or chest pain, and chronic iron deficiency anemia may also occur. •
Jackhammer esophagus (hypercontractile peristalsis): Intense long-lasting esophageal muscle spasm. •
Acute cholecystitis: Characterized by positive
Murphy's sign where the person has a cessation of
inhalation when the doctor places his finger at the right subcostal region of the abdomen. •
Acute pancreatitis: History of
excessive alcohol use,
cholelithiasis (stones in the gallbladder), and
hypertriglyceridemia are risk factors for pancreatitis. The pain is described as sharp, burning, and can worsen after eating. •
Perforated peptic ulcer: Sudden onset of severe pain in the upper abdomen which later develops into
peritonitis (inflammation of tissues that lines the abdominal organs). •
Acute gastritis: Common presentations include upper gastrointestinal issues such as epigastric pain, heartburn, bloating, and a feeling of early fullness
Chest wall •
Costochondritis or
Tietze's syndrome: An inflammation of a costochondral junction. Any movements or
palpation of the chest can reproduce the symptoms. •
Spinal nerve problem •
Fibromyalgia: Fibromyalgia is a chronic condition presenting with but not limited to widespread musculoskeletal pain, often accompanied by fatigue, sleep disturbances, and cognitive difficulties. Symptoms can vary widely; common reports include chest pain, muscle weakness, abdominal cramps, dizziness, insomnia, and numbness or tingling •
Chest wall problems: Chest pain can arise from musculoskeletal issues ie scleroderma, costochondritis, cervical radiculitis, among others. •
Bornholm disease: Bornholm disease is a viral illness marked by a brief febrile episode accompanied by sharp pains in the lower chest or upper abdomen. The condition may also involve muscle tenderness and localized swelling, with chest pain being a prominent symptom. •
Rib fracture: Rib fractures often cause pain that intensifies with deep breathing, leading people to breathe shallowly to minimize discomfort, especially after trauma. In individuals with a history of cancer, rib metastases should be considered if symptoms like tenderness, weight loss, fatigue, and reduced appetite are present.
Psychological •
Panic attack: Chest pain is a common symptom of panic attacks, with as high as 78% of persons describing chest pain with their worst panic attacks. Overall chest pain is a symptom of up to 48% of sudden-onset panic attacks, and 10% of gradual-onset panic attacks. •
Clinical depression: Depression, linked to chest pain through its physical and emotional effects, has been shown in studies to independently increase the long-term risk of coronary heart disease (CHD) and myocardial infarction (MI), potentially contributing to cardiovascular disease. •
Somatization disorder: Somatization disorder can present with chronic physical symptoms without an identifiable medical cause; it often manifests as chest pain and results from underlying psychological distress •
Hypochondria Others •
Hyperventilation syndrome often presents with chest pain and a tingling sensation of the fingertips and around the mouth. •
Tuberculosis: Chest pain associated with tuberculosis often arises from tuberculous pericarditis, a condition caused by Mycobacterium tuberculosis affecting the pericardium. This inflammation typically results in symptoms such as chest discomfort, coughing, fever, night sweats, and unintentional weight loss •
Da Costa's syndrome •
Carbon monoxide poisoning: Chest pain, along with symptoms like headache, dizziness, nausea, and confusion, can occur as a result of carbon monoxide poisoning, which is often mistaken for the flu due to its nonspecific presentation •
Sarcoidosis: Cardiac sarcoidosis involves the formation of granulomas (clusters of inflammatory cells) within the heart tissue, which can lead to chest pain due to inflammation and fibrosis •
Lead poisoning: Chest pain associated with lead poisoning may result from its impact on the cardiovascular system, including hypertension or vascular damage, often occurring in conjunction with fatigue and abdominal pain • Prolapsed
intervertebral disc •
Thoracic outlet syndrome: Occurs when nerves or blood vessels are compressed in the space between the first rib and the collarbone, causing symptoms such as pain in the neck, shoulder, or chest, along with arm weakness or numbness •
Adverse effect from certain medications == Pathophysiology ==