Some Causes and Features of Chest Pain

Causes	Common Features*	Tests†
Heart disorders
Heart attack (myocardial infarction) or unstable angina	Immediately life threatening Dull, aching, squeezing, or crushing pain, sometimes sudden that Spreads to the jaw or arm May be constant or come and go Sometimes shortness of breath or nausea Pain that occurs during exertion and is relieved by rest (angina pectoris) Certain abnormal heart sounds, heard through a stethoscope Often warning signs‡	ECG, done several times over a period of time Blood tests to measure substances that indicate heart damage (cardiac biomarkers) If ECG and cardiac biomarker levels are normal, often CT of heart arteries or a stress test If ECG or cardiac biomarker levels are abnormal, heart catheterization
Thoracic aortic dissection (a tear in the wall of the part of aorta in the chest)	Immediately life threatening Sudden, tearing pain that spreads to or starts in the middle of the back Sometimes light-headedness, stroke, or pain, coldness, or numbness in a leg (indicating inadequate blood flow to the leg) Sometimes a pulse or blood pressure in one limb that differs from that in the other limb Usually in people who are over 55 years and have a history of high blood pressure Warning signs‡	Chest x-ray studies An imaging study of the aorta CT scan of the aorta Transesophageal echocardiography (ultrasound study of the heart with the ultrasound device passed down the throat) MRI study of the aorta
Pericarditis (inflammation of the membrane around the heart)	Potentially life threatening Sharp pain that Is constant or comes and goes Is often worsened by breathing, swallowing food, or lying on the back Is relieved by leaning forward An abnormal heart sound, heard through a stethoscope	ECG Echocardiography (ultrasound study of the heart) Sometimes MRI study
Digestive tract disorders
Esophageal rupture	Immediately life threatening Sudden, severe pain immediately after vomiting or after a medical procedure involving the esophagus (such as endoscopy of the esophagus and stomach or transesophageal echocardiography) Several warning signs‡	Chest x-ray studies X-ray studies of the esophagus taken after the person swallows water-soluble contrast (esophagography)
Pancreatitis (inflammation of the pancreas)	Potentially life threatening Severe, constant pain that Occurs in the upper middle of the abdomen or in the lower chest Is often worse when lying flat Is relieved by leaning forward Vomiting Upper abdominal tenderness Sometimes shock Often in people who abuse alcohol or who have gallstones	Blood tests to measure an enzyme (lipase) produced by the pancreas Sometimes CT scans of the abdomen
Peptic ulcer§	Recurring, vague discomfort that Occurs in the upper middle of the abdomen or lower chest Is relieved by antacids and sometimes by food Often in people who smoke, drink alcohol, or do both Often no warning signs‡	A doctor's examination Sometimes endoscopy
Gastroesophageal reflux (GERD)§	Typically, recurring, burning pain that Spreads from the upper middle of the abdomen to the throat Is worsened by bending over or lying down Is relieved by antacids	A doctor's examination Sometimes endoscopy
Gallbladder and bile duct disorders (biliary tract disease)§	Recurring discomfort that Occurs in the upper right of the abdomen or the lower middle of the chest, and sometimes radiates to the right shoulder Occurs after meals (but not after exertion)	Ultrasound study of the gallbladder Sometimes hepatobiliary scan (HIDA)
Swallowing disorders in which there is abnormal movement (propulsion) of food through the esophagus§	Pain that Has developed gradually over a long period of time May or may not occur during swallowing Usually difficulty swallowing	Sometimes x-ray studies of the upper digestive tract after barium is given by mouth (barium swallow) A test to determine whether contractions in the digestive tract are normal (esophageal manometry)
Lung disorders
Pulmonary embolism (blockage of an artery in the lungs by a blood clot)	Immediately life threatening Often sharp pain when breathing in, shortness of breath, rapid breathing, and a rapid heart rate Sometimes mild fever, coughing up blood, or shock More likely in people with risk factors for pulmonary embolism (such as previous blood clots, recent surgery especially surgery on the legs, prolonged bed rest, a cast or splint on a leg, older age, smoking, or cancer)	CT angiography or nuclear scanning of the lungs Sometimes a blood test to detect blood clots (D-dimer test)
Tension pneumothorax (a collapsed lung with a high-pressure buildup of air in the chest)	Immediately life threatening Significant shortness of breath Low blood pressure, swollen neck veins, and weak breath sounds on one side, heard through a stethoscope Typically occurs only after a severe chest injury	Usually only a doctor's examination Sometimes chest x-ray study or ultrasound scan
Pneumonia	Potentially life threatening Fever, chills, cough, and usually yellow or green phlegm Often shortness of breath Sometimes pain when breathing in A rapid heart rate and congested lungs, detected during the examination	Chest x-ray studies
Pneumothorax (a collapsed lung)	Potentially life threatening Sudden, sharp pain, usually on one side of the chest Sometimes shortness of breath Sometimes weak breath sounds on one side, heard through a stethoscope	Chest x-ray study or ultrasound scan
Pleuritis (inflammation of the membrane around the lung)§	Sharp pain when breathing Usually in people who have recently had pneumonia or a viral respiratory infection Sometimes cough No warning signs‡	Usually only a doctor's examination
Other disorders
Pain in the chest wall,including the muscles, ligaments, nerves, and ribs (musculoskeletal chest wall pain)§	Pain that Is typically persistent (lasting days or longer) Is worsened by movement and/or breathing May have no apparent cause or may result from coughing or overuse Tenderness maximally in one spot on the chest No warning signs‡	Only a doctor's examination
Fibromyalgia	Pain that is Nearly constant Affects widespread areas of the body Is usually accompanied by fatigue and poor sleep quality	Only a doctor's examination
Shingles§	Sharp pain in a band around the chest and often the back but only on one side A rash of many small blisters. sometimes filled with pus, in the painful area and sometimes appearing only after the pain	Only a doctor's examination
Cancers of the chest or chest wall	Sometimes pain that is worse when breathing in Sometimes chronic cough, smoking history, weight loss, swelling of lymph nodes in the neck	Chest x-ray study Chest CT scan
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.
† For most people with chest pain, the oxygen level in blood is measured with a sensor placed on a finger (pulse oximetry), ECG is done, and a chest x-ray study is taken.
‡ Warning signs include Abnormal vital signs (an abnormally slow or fast heart rate, rapid breathing, and abnormally low blood pressure) Signs of decreased blood flow (such as confusion, pale or gray skin color, and excessive sweating) Shortness of breath Abnormal breath sounds or pulses New heart murmurs
§ Unless otherwise described, causes are usually not dangerous, although they are uncomfortable.
CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging.

Causes

Common Features*

Tests†

Heart disorders

Heart attack (myocardial infarction) or unstable angina

Immediately life threatening

Dull, aching, squeezing, or crushing pain, sometimes sudden that

Spreads to the jaw or arm
May be constant or come and go

Sometimes shortness of breath or nausea

Pain that occurs during exertion and is relieved by rest (angina pectoris)

Certain abnormal heart sounds, heard through a stethoscope

Often warning signs‡

ECG, done several times over a period of time

Blood tests to measure substances that indicate heart damage (cardiac biomarkers)

If ECG and cardiac biomarker levels are normal, often CT of heart arteries or a stress test

If ECG or cardiac biomarker levels are abnormal, heart catheterization

Thoracic aortic dissection (a tear in the wall of the part of aorta in the chest)

Immediately life threatening

Sudden, tearing pain that spreads to or starts in the middle of the back

Sometimes light-headedness, stroke, or pain, coldness, or numbness in a leg (indicating inadequate blood flow to the leg)

Sometimes a pulse or blood pressure in one limb that differs from that in the other limb

Usually in people who are over 55 years and have a history of high blood pressure

Warning signs‡

Chest x-ray studies

An imaging study of the aorta

CT scan of the aorta
Transesophageal echocardiography (ultrasound study of the heart with the ultrasound device passed down the throat)
MRI study of the aorta

Pericarditis (inflammation of the membrane around the heart)

Potentially life threatening

Sharp pain that

Is constant or comes and goes
Is often worsened by breathing, swallowing food, or lying on the back
Is relieved by leaning forward

An abnormal heart sound, heard through a stethoscope

ECG

Echocardiography (ultrasound study of the heart)

Sometimes MRI study

Digestive tract disorders

Esophageal rupture

Immediately life threatening

Sudden, severe pain immediately after vomiting or after a medical procedure involving the esophagus (such as endoscopy of the esophagus and stomach or transesophageal echocardiography)

Several warning signs‡

Chest x-ray studies

X-ray studies of the esophagus taken after the person swallows water-soluble contrast (esophagography)

Pancreatitis (inflammation of the pancreas)

Potentially life threatening

Severe, constant pain that

Occurs in the upper middle of the abdomen or in the lower chest
Is often worse when lying flat
Is relieved by leaning forward

Vomiting

Upper abdominal tenderness

Sometimes shock

Often in people who abuse alcohol or who have gallstones

Blood tests to measure an enzyme (lipase) produced by the pancreas

Sometimes CT scans of the abdomen

Peptic ulcer§

Recurring, vague discomfort that

Occurs in the upper middle of the abdomen or lower chest
Is relieved by antacids and sometimes by food

Often in people who smoke, drink alcohol, or do both

Often no warning signs‡

A doctor's examination

Sometimes endoscopy

Gastroesophageal reflux (GERD)§

Typically, recurring, burning pain that

Spreads from the upper middle of the abdomen to the throat
Is worsened by bending over or lying down
Is relieved by antacids

A doctor's examination

Sometimes endoscopy

Gallbladder and bile duct disorders (biliary tract disease)§

Recurring discomfort that

Occurs in the upper right of the abdomen or the lower middle of the chest, and sometimes radiates to the right shoulder
Occurs after meals (but not after exertion)

Ultrasound study of the gallbladder

Sometimes hepatobiliary scan (HIDA)

Swallowing disorders in which there is abnormal movement (propulsion) of food through the esophagus§

Pain that

Has developed gradually over a long period of time
May or may not occur during swallowing

Usually difficulty swallowing

Sometimes x-ray studies of the upper digestive tract after barium is given by mouth (barium swallow)

A test to determine whether contractions in the digestive tract are normal (esophageal manometry)

Lung disorders

Pulmonary embolism (blockage of an artery in the lungs by a blood clot)

Immediately life threatening

Often sharp pain when breathing in, shortness of breath, rapid breathing, and a rapid heart rate

Sometimes mild fever, coughing up blood, or shock

More likely in people with risk factors for pulmonary embolism (such as previous blood clots, recent surgery especially surgery on the legs, prolonged bed rest, a cast or splint on a leg, older age, smoking, or cancer)

CT angiography or nuclear scanning of the lungs

Sometimes a blood test to detect blood clots (D-dimer test)

Tension pneumothorax (a collapsed lung with a high-pressure buildup of air in the chest)

Immediately life threatening

Significant shortness of breath

Low blood pressure, swollen neck veins, and weak breath sounds on one side, heard through a stethoscope

Typically occurs only after a severe chest injury

Usually only a doctor's examination

Sometimes chest x-ray study or ultrasound scan

Pneumonia

Potentially life threatening

Fever, chills, cough, and usually yellow or green phlegm

Often shortness of breath

Sometimes pain when breathing in

A rapid heart rate and congested lungs, detected during the examination

Chest x-ray studies

Pneumothorax (a collapsed lung)

Potentially life threatening

Sudden, sharp pain, usually on one side of the chest

Sometimes shortness of breath

Sometimes weak breath sounds on one side, heard through a stethoscope

Chest x-ray study or ultrasound scan

Pleuritis (inflammation of the membrane around the lung)§

Sharp pain when breathing

Usually in people who have recently had pneumonia or a viral respiratory infection

Sometimes cough

No warning signs‡

Usually only a doctor's examination

Other disorders

Pain in the chest wall,including the muscles, ligaments, nerves, and ribs (musculoskeletal chest wall pain)§

Pain that

Is typically persistent (lasting days or longer)
Is worsened by movement and/or breathing
May have no apparent cause or may result from coughing or overuse

Tenderness maximally in one spot on the chest

No warning signs‡

Only a doctor's examination

Fibromyalgia

Pain that is

Nearly constant
Affects widespread areas of the body
Is usually accompanied by fatigue and poor sleep quality

Only a doctor's examination

Shingles§

Sharp pain in a band around the chest and often the back but only on one side

A rash of many small blisters. sometimes filled with pus, in the painful area and sometimes appearing only after the pain

Only a doctor's examination

Cancers of the chest or chest wall

Sometimes pain that is worse when breathing in

Sometimes chronic cough, smoking history, weight loss, swelling of lymph nodes in the neck

Chest x-ray study

Chest CT scan

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

† For most people with chest pain, the oxygen level in blood is measured with a sensor placed on a finger (pulse oximetry), ECG is done, and a chest x-ray study is taken.

‡ Warning signs include

Abnormal vital signs (an abnormally slow or fast heart rate, rapid breathing, and abnormally low blood pressure)
Signs of decreased blood flow (such as confusion, pale or gray skin color, and excessive sweating)
Shortness of breath
Abnormal breath sounds or pulses
New heart murmurs

§ Unless otherwise described, causes are usually not dangerous, although they are uncomfortable.

CT = computed tomography; ECG = electrocardiography; MRI = magnetic resonance imaging.

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Chest Pain