Acute chest pain is a common complaint in the medical practice that may be a sign of minor medical illness but at times it may herald a serious life threatening process that requires immediate attention.
We are going to list all common causes of chest pain and classify them as minor or serious followed by brief description of each cause, we will provide at the end specific guidance as to when to seek immediate medical attention.
Muscles, bones and joints
- Costochondritis (rib joints inflammation)
- Rib fracture or bruising
- Arthritis of shoulder and spine
- Cervical spine disc.
- Stomach ulcer
- Esophagus reflux or spasm
- Gall Bladder disease
- Herpes Zoster
- Panic attack
- Heart attack and related Coronary arteries syndromes
- Very fast heart beat
- Aortic dissection
- Pulmonary Embolism (blood clot in lung)
- Pneumothorax (lung tear causing air leak to the chest cavity)
Serious Causes of Chest Pain: All need immediate ER
Leakage of air from the lung tissue to the space between the lung and chest wall (Pleural space).
It can happen spontaneously in smokers with thin blebs at lung surface, after trauma or medical procedure.
It causes sudden sharp one sided chest pain with severe shortness of breath
“The great masquerader”
It is usually caused by a blood clot in the leg (DVT) or pelvic veins
Risk factors are:
Cancer, obesity, heart failure, birth control pills, hereditary, recent surgery, sedentary life style.
The clot travels with the venous blood and reaches the lungs where it gets trapped blocking blood flow through the lungs, its size will determine the symptoms:
- Massive Clot 5-10%—>Chest pain, severe shortness of breath, dizziness passing out, low oxygen with blue patient, it can be fatal
- Submissive Clot 20-25%—> mild symptoms :unexplained chest discomfort and mild shortness of breath)
- Low risk clot 70-75%—> minimal nonspecific symptoms and excellent prognosis
***Having pre-existing lung or heart disease will cause more severe symptoms and worse result
Dissecting Aortic Aneurysm
The Aorta is the main vessel that carries oxygenated blood from the heart to the entire body. Aneurysm means abnormal swelling or dilatation of an artery (becoming like a balloon ) with thinner wall at certain point of its course.
Smoking and hypertension in addition to other uncommon diseases (Marfan’s syndrome) increases the risk for aneurysm formation.
Dissection means a tear in the lining of the Aorta allowing blood to flow between its wall layers.
Acute Aortic dissection May cause sudden sharp ripping chest or upper back pain. It may also cause loss of consciousness or sudden heart failure (sudden chest congestion and shortness of breath)
Heart Disease and Coronary Arteries Occlusion
The heart muscle receives oxygen through the coronary arteries.
The classic chest heaviness experienced in patients with heart disease is called Angina.
Coronary artery(ies) narrowing causes Angina and or other symptoms.
Risk factors for Coronary artery disease are: Hypertension, Diabetes, High Cholesterol, Obesity, Smoking and Family history for premature onset heart disease
Heart attack is caused by blood clot occluding a coronary artery.
Below is a cross section of a Coronary artery vessel to explain different Heart pain presentations:
- Normal patent coronary artery —> no symptom.
- Narrow artery due to atherosclerosis (fat deposit)—> reduced blood flow —> chest pain after fixed amount of exertion —> Stable Angina
- Narrow artery with ulcerated lining inviting blood to clot but not totally occluding —> chest pain at rest or with minimal exertion—> Unstable Angina
- Narrow artery with clot totally occluding blood flow—> part of the heart muscle will die —> Myocardial Infarction (heart attack)
- Classic heart pain is Pressure and heaviness in the center of chest with radiation to left arm and jaw
- Different quality of pain is possible
- Pain may radiates to back or right shoulder
- Abdomen pain can be at times a sign of a heart attack
- Shortness of breath is common
- Sweating and nausea with fatigue are common
- Diabetics tend to have atypical presentation due to diseased nerves with altered sensation
- The size of the heart attack will greatly determine the severity of symptoms and the prognosis (outcome)
Non Serious Causes Of Chest Pain
Chest Wall cause
Costochondritis and Tietze Syndrome
- Inflammation and swelling in rib joint or joints
- Usually the 3rd , 4th or 5th
- Usually young person , more common in females
- It causes sharp pain, sudden or gradual onset
- Pain is worse with coughing, sneezing or deep breathing or twisting motion of chest
- Pain is reproduced by pushing on the tender joint
- Treatment is anti inflammatory or Steroid injection
- It is caused by inflammation of the Pleura
- The Pleura has 2 layers , one is lining the chest cavity, the other is covering the lungs ,there is a small amount of fluids within the pleural space allowing the lungs to expand with minimal friction
- The lung tissue has no pain sensation, the Pleura has
- The pain is usually sharp and induced by deep breathing or coughing
- Pain is localized to one lung and only part of the pleura covering the lung
- Viral infection is a common cause but any Lung disease that extends to the pleura can cause similar (pleuritic pain) like infection, inflammation cancer and clot
- Treatment is anti inflammatory and analgesics (after ruling out serious cause)
- Any lung infection that extends to the Pleura can cause sharp pain
- The pain is localized over the infected part of the lung
- Pneumonia causes a productive cough, trouble breathing and fever.
- Pain is in upper center of abdomen (Epigastric) and mid chest
- Aching and burning
- Relieved with food and antacids
- Pain is in upper center of abdomen and mid chest, sometimes goes to neck
- Aching, burning and discomfort
- Relieved with antacids
Gall Bladder Disease
- Pain is in right upper and mid upper abdomen
- Pain shoots (radiates) to back and right shoulder
- Pain is indigestion, pressure and cramping
- Triggered by fatty meals
- Usually associated with nausea and vomiting
Medical Care One is an urgent care and Walk-in clinic in Ypsilanti. Many patients visit us for immediate treatment of unexpected illnesses and injuries, as well as for routine exams. We are also fully equipped and staffed for preventative medicine, and occupational medicine services, as well. At Our Urgent Care you will be seen right away. You will be examined, and treated in less than an hour. Urgent Care Online: Meet your doctor online via Telemedicine. We are a COVID-19 Testing Center. For More Information, call (734) 330-2800