Chest Pain

Origin of Pain

“Chest pain” is a symptom with many possible sources - from harmless muscle strain to life-threatening conditions of the heart, lungs, and great vessels. Dangerous causes can masquerade as “ordinary” pain, so significant symptoms require prompt evaluation.

Brief Overview

  • Likely sources: heart, lungs/pleura, chest wall/nerves, esophagus & stomach.

  • Pain character can suggest a cause, but self-diagnosis is not recommended.

  • Basic screening: exam + ECG + chest X-ray (with extended tests as indicated).

  • If red flags are present, seek urgent medical care.

Common Causes

Cardiac

  • Acute coronary syndrome (ischemia/myocardial infarction)

  • Pericarditis, myocarditis

Pulmonary / Pleural

  • Pulmonary embolism (PE)

  • Pneumonia, pleurisy

  • Pneumothorax (air in the pleural space)

Musculoskeletal / Neuropathic

  • Costochondritis/Tietze syndrome

  • Intercostal neuralgia, muscle strain

  • Rib contusion/fracture

Gastrointestinal

  • GERD/reflux, esophageal spasm

  • Peptic ulcer disease (referred pain)

Other

  • Shingles (herpes zoster)

  • Anxiety/panic attacks

Symptoms & Typical Patterns

  • Myocardial ischemia: pressure/tightness behind the sternum; may radiate to left arm/neck/jaw; shortness of breath, cold sweat, nausea.

  • Pleurisy/pneumonia: sharp, stabbing pain worse with deep breath or cough; possible fever and weakness.

  • Pneumothorax: sudden “knife-like” pain with dyspnea, often after exertion/trauma; more common in tall, slim smokers.

  • Musculoskeletal pain: localized; reproduced by palpation or movement.

  • Reflux (GERD): burning behind the sternum after meals/at night; relief with antacids.

  • PE: sudden pleuritic pain, shortness of breath, tachycardia; sometimes hemoptysis.
     

Red Flags — Seek Immediate Care

  • Sudden severe chest pain with shortness of breath, fainting, or marked weakness.

  • Crushing/burning pain radiating to the left arm or jaw plus cold sweat or nausea.

  • Coughing up blood, blue lips/fingers, very fast or irregular pulse.

  • Chest trauma with deformity or sharp worsening on breathing.

  • High fever (≥38.5 °C) with significant breathlessness/toxicity.

Risk Factors

  • Cardiac: age, hypertension, diabetes, dyslipidemia, smoking, family history of early CVD.

  • PE: recent surgery/immobilization/long flight, pregnancy, OCP/HRT, active cancer, thrombophilia.

  • Pneumothorax: tall/slim habitus, smoking, chronic lung disease, recent procedure/trauma.

  • GERD: obesity, late meals, alcohol, hiatal hernia, certain medications.

Diagnosis

  • Clinical exam: vital signs, oxygen saturation, inspection and palpation of the chest wall.

  • Rapid tests: ECG, pulse oximetry; troponin if ischemia is suspected.

  • Imaging:

    • Chest X-ray as the first-line test in many scenarios.

    • CT pulmonary angiography for suspected PE (guided by risk scores/D-dimer).

    • Point-of-care ultrasound (where available) to look for pleural/pericardial effusion.

  • Laboratory: CBC, CRP; D-dimer by pretest probability; basic metabolic panel as indicated.

  • Additional: GI evaluation (reflux/spasm), dermatology (rash), spirometry (asthma/COPD) as needed.

What You Can Do Before Seeing a Doctor (if no red flags)

  • Rest; avoid exertion; keep a brief symptom log (onset, duration, triggers, associated signs).

  • A short course of over-the-counter analgesics only if safe for you (e.g., no ulcer/bleeding risks). Do not self-start antibiotics.

  • Avoid smoking and alcohol; ventilate and humidify the room.

  • If symptoms worsen or red flags appear, switch to emergency care immediately.

Which Doctor to See

  • Start with a general practitioner/family doctor.

  • Based on findings, you may be referred to a cardiologist, pulmonologist, gastroenterologist, trauma/orthopedics, neurologist, or dermatologist (if rash is present).