The Many Causes of Chest Pain

Female doctor examining patient with stethoscope
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Chest pain is not a symptom you should ever ignore, for obvious reasons. Chest pain, as almost anyone knows, may indicate a cardiac problem. For this reason alone, if you have chest pain you should be evaluated by a doctor. Making an expeditious diagnosis of angina (chest discomfort caused by insufficient blood flow to the heart muscle), or even an actual heart attack, can permit the appropriate treatment to prevent permanent heart damage.

But cardiac conditions are not the only important cause of chest pain. It turns out that chest discomfort is a common symptom that accompanies many different medical problems, and many people who are evaluated for chest pain are diagnosed with conditions that have nothing to do with the heart. Some of the non-cardiac medical problems that can cause chest pain are quite significant and require aggressive treatment. Others are much more benign, and can often treated with reassurance.

But either way, if you have chest pain — whether or not it turns out to be cardiac in nature — you need to be seen by a doctor. That’s the only way to know for sure what is causing this alarming symptom, and to make sure you’re getting the right treatment.

What Is Chest Pain?

"Chest pain" is a less precise term than you might think. “Chest pain” may be used by both doctors and patients to describe symptoms not actually localized to the chest, but that may occur in the chest, neck, or upper abdomen, often associated with discomfort in the jaw, head, or arms.

Furthermore, the “pain” may not actually be painful. Rather, it often manifests as a pressure-like sensation, or squeezing, choking, numbness or some other type of discomfort. Depending on the underlying cause, the symptoms can last from less than a second to days or weeks, can occur frequently or rarely, and might occur either sporadically and unpredictably, or under specific conditions and quite predictably.

The reason "chest pain" encompasses such a broad range of symptoms is that chest pain can be produced by a similarly broad range of medical conditions. Because chest pain can accompany medical conditions ranging from catastrophic to trivial, when a person experiences chest pain it is important for a doctor to characterize that pain as rapidly as possible, to determine whether it represents a problem that is likely benign, or is instead a serious issue that needs immediate medical attention.

What Medical Conditions Can Cause Chest Pain?

Chest pain can be caused by medical conditions affecting any of the organs located in the chest or upper abdomen, including the heart, blood vessels, lungs, airways, muscles, bones, esophagus or stomach.

Here is a list of the more common causes of chest pain, roughly in the order in which they are seen in a typical hospital emergency room. Follow the links provided for more details on each condition: 

• ”Typical” angina due to coronary artery disease

• Acute coronary syndrome, which may include unstable angina or a frank heart attack.

• Heartburn is a common cause of chest pain, and if untreated can lead to serious consequences. 

• Chest wall pain (musculoskeletal chest pain) is more common than many people realize, and while not particularly significant from a medical standpoint, it can be quite alarming and anxiety-provoking.

• Anxiety or panic disorder is commonly accompanied by chest pain.

• Pulmonary problems — asthma, bronchitis, pneumonia, pleuritis — often produces chest pain.

• Mitral valve prolapse (MVP) is often blamed for episodes of chest pain, though probably causes chest pain much less often than doctors tend to believe.

• Pericarditis typically produces chest pain.

• Peptic ulcer disease may produce pain that is perceived as coming from the chest.

• Angina due to coronary artery spasm.

• Angina due to microvascular coronary artery disease.

• Aortic dissection is a catastrophic condition that produces sudden, severe chest pain.

What Should You Do If You Have Chest Pain?

From this long list of conditions that can produce chest pain, it should be obvious that, if you have chest pain, you need to be evaluated by a doctor.

But how can you tell if your chest pain is dangerous, or constitutes an emergency? And what should you expect the doctor to do in order to make a quick and accurate diagnosis? While there are no hard and fast rules to answer these questions, there are some general guidelines that can be very helpful.  Read more about this general approach to evaluating chest pain:

A Word From Verywell

“Chest pain” is a term loosely used to describe any unusual or disturbing pain or discomfort that occurs in the general area of the chest. While in many cases chest pain turns out to be due to a benign condition, all too often it indicates a serious, potentially life-threatening medical problem. So chest pain is one symptom you should never ignore. 

Sources: 

Bösner S, Becker A, Haasenritter J, et al. Chest Pain in Primary Care: Epidemiology and Pre-work-up Probabilities. Eur J Gen Pract 2009; 15:141.

Ebell MH. Evaluation of Chest Pain in Primary Care Patients. Am Fam Physician 2011; 83:603.

Wertli MM, Ruchti KB, Steurer J, Held U. Diagnostic Indicators of Non-Cardiovascular Chest Pain: a Systematic Review and Meta-analysis. BMC Med 2013; 11:239.

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