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What is chest pain? What other symptoms might occur with chest pain? What causes chest pain? How is chest pain diagnosed? Questions the doctor may ask about chest pain What is the philosophy of the approach to chest pain diagnosis? What is the diagnosis and treatment for chest pain? |
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Questions the doctor may ask about chest pain When did the pain start? What is the quality of the pain? How long does the pain last? Does the pain come and go? What makes the pain better? What makes the pain worse? Does the pain radiate somewhere (move to another area of the body)? Has there been any preceding illness? Has there been any trauma? Have there been similar episodes of pain in the past? Is the pain different than that of a previous condition that has been experienced, or is it similar? Questions about the associated symptoms Is there shortness of breath? Fever or chills? Cough? Nausea or vomiting? Sweating? Questions about risk factors for disease Risk factors for atherosclerotic heart disease (also known as coronary artery disease) Smoking High blood pressure High cholesterol Diabetes Family history Risk factors for pulmonary embolus (blood clot to the lung) Prolonged inactivity such as bed rest, long car or airplane trips Recent surgery Fractures Birth control pill use (particularly if the patient smokes cigarettes) Cancer Risk factors for aortic dissection High blood pressure Marfan syndrome Ehlers-Danlos syndrome Polycystic kidney disease Cocaine use Pregnancy Questions about the associated symptoms Is there shortness of breath? Fever or chills? Cough? Nausea or vomiting? Sweating? Questions about risk factors for disease Risk factors for atherosclerotic heart disease (also known as coronary artery disease) Smoking High blood pressure High cholesterol Diabetes Family history Risk factors for pulmonary embolus (blood clot to the lung) Prolonged inactivity such as bed rest, long car or airplane trips Recent surgery Fractures Birth control pill use (particularly if the patient smokes cigarettes) Cancer Risk factors for aortic dissection High blood pressure Marfan syndrome Ehlers-Danlos syndrome Polycystic kidney disease Cocaine use Pregnancy Chest wall Palpate for rib or muscle tenderness Look for rashes including the rash of shingles (zoster) Lungs Listen for abnormal lung sounds like crackle or wheeze or decreased air entry with inspiration Listen for rubs (a friction sound made by two rough surfaces rubbing against each other) that may be heard in pleurisy Heart Listen for abnormal heart sounds, murmurs or rubs (which may be heard with inflammation of the heart lining, called pericarditis) Listen for muffled or indistinct heart tones that can be associated with excess fluid in the pericardium, the sac that surrounds the heart Abdomen Palpate for tenderness or masses Listen for bruits over the aorta Extremities Feel for pulses What causes chest pain? Chest pain is caused by a variety of mild to serious disorders, diseases or conditions. Chest pain can result from infection, infarction, inflammation, trauma, malignancy, and other abnormal processes. While many cases of chest pain are due to problems with the heart, chest pain can also be due to respiratory diseases, problems with digestion, anxiety disorders, or a pulled muscle or tendon. In children, chest pain is usually not caused by a heart attack, but may be caused by a serious congenital heart condition or birth defect. Life-threatening cardiovascular causes of chest pain Chest pain can arise from problems with the structures surrounding the heart and the heart itself including: * Aortic dissection * Cardiac arrhythmias (irregular heart rhythms) * Congenital cardiac anomalies and disorders and birth defects, such as coarctation of the aorta and aortic valve stenosis * Congestive heart failure * Coronary artery disease (heart disease) including coronary artery spasm or angina due to atherosclerosis (hardening and narrowing of the arteries) * Endocarditis (inflammation or infection of the inner lining of the heart) * Heart attack * Mitral valve prolapse and other heart valve problems * Pericarditis (inflammation or infection of the lining that covers the heart) Serious or life-threatening lung-related causes of chest pain Chest pain can also be caused by serious problems with the respiratory system including: * Asthma * Bronchitis * Chronic obstructive pulmonary disease (COPD) * Pleurisy (inflammation of the lung lining) * Pneumonia * Pneumothorax or hemothorax (collapsed lung or blood around the lung) * Pulmonary edema * Pulmonary embolism * Pulmonary hypertension Digestive system-related causes of chest pain Chest pain can arise from gastrointestinal problems including: * Achalasia (disorder of the esophagus) * Barrett’s esophagus (abnormal lining of the esophagus caused by stomach acid) * Heartburn * Esophageal spasm * Gallbladder conditions, such as cholecystitis (inflammation of the gallbladder) and gallstones * Gastritis * Gastroesophageal reflux disease (GERD) * Hiatal hernia (abnormal movement of the stomach into the chest) * Pancreatitis and other pancreas conditions * Peptic ulcer Other causes of chest pain Other causes of chest pain include psychological and inflammatory conditions: * Anxiety attack * Chest injury or trauma, such as rib fracture or a bruised chest * Costochondritis (inflammation of the ribs and breastbone) * Pulled chest wall muscle (muscle strain) * Shingles What are the potential complications of chest pain? The complications of untreated or poorly controlled chest pain vary depending on the underlying disease, disorder or condition. Any kind of chest pain, whether it occurs alone or is accompanied by other symptoms, should be evaluated by your doctor or health care provider. Once the underlying cause is identified, following the treatment plan you and your health care provider develop specifically for you will minimize the risk of complications of serious or life-threatening underlying causes of chest pain including: * Cardiac arrest * Cardiac arrhythmias (abnormal heart rhythm) * High carbon dioxide levels and acidosis * Low oxygen levels * Respiratory failure and respiratory arrest * Sepsis * Shock What other symptoms might occur with chest pain? Chest pain often occurs in conjunction with other symptoms, which vary depending on the underlying disease, disorder or condition. For example, if chest pain is related to an infection, you may experience a fever and body aches. Diseases and conditions of organs and tissues in your chest or abdomen, such as the lungs, stomach, esophagus, ribs, pancreas, gallbladder, muscles and nerves, can result in chest pain as well. Pain can also travel from the neck, back and belly area to your chest. Coexisting symptoms can also be related to the digestive tract. Some signs or symptoms, such as low oxygen levels and high carbon dioxide levels, may be evident only through medical testing, so always seek medical care if you are experiencing chest pain. Other chest symptoms that may occur along with chest pain Chest pain may accompany other heart and lung symptoms including: * Cough (may be a productive cough with phlegm) * Flared nostrils * Wheezing Digestive symptoms that may occur along with chest pain Chest pain can accompany symptoms related to the digestive system including: * Abdominal pain * Difficulty swallowing, possibly with a sore throat * Feeling that food is stuck in your chest * Food regurgitation * Nausea and vomiting Other symptoms may occur along with chest pain Other symptoms that may accompany chest pain include: * Anxiety and feelings of panic or fear * Racing thoughts * Stress * Sweating palms Serious symptoms that might indicate a life-threatening condition Chest pain may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) for symptoms including: * Change in level of consciousness or alertness, such as passing out or unresponsiveness * Chest pain that spreads to the left arm, jaw, or shoulder, or to the back * Chest pain when breathing or coughing * Cold, clammy skin or cyanosis, a bluish color of the skin, lips or nails * Coughing up yellow-green phlegm (mucus) with shortness of breath or wheezing * Dizziness or disorientation * Heart palpitations or a fluttering feeling in the chest * High fever (higher than 101 degrees Fahrenheit) * Pressure, cramping, tightness, or tearing sensation in the chest * Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking * Sweating |