What Causes Chest Pain?

Quite a few reasons can cause chest pain. 

  1. Disease on chest wall
    • acute inflammation of skin and subcutaneous tissue
    • herpes zoster – can cause severe pain
    • intercostal neuritis
    • rib fracture
    • costal cartilage inflammation
    • blood disease-induced bone pain (acute leukemia, multiple myeloma)
  2. Pleural and lung disease
    • acute pleurisy (tuberculous pleurisy, etc.)
    • spontaneous pneumothorax
    • acute pulmonary embolism
    • pleural and lung tumors
  3. Cardiovascular disease
    • acute coronary syndrome
    • aortic dissection
    • cardiac tamponade
    • heart crush injury (impact injury)
    • stable angina pectoris
    • myocarditis
    • hypertrophic obstructive cardiomyopathy
    • aortic valve disease
    • mitral valve prolapse
    • acute pericarditis
  4. Digestive tract diseases
    • esophageal disorders including gastroesophageal reflux disease,esophageal spasm, esophageal fissure hiatal, acute esophagitis, esophageal inflammation, esophageal cancer
    • abscess of the diaphragm, bacterial liver abscess, liver cancer, liver congestion, cholelithiasis, ulcer and perforation can have right lower chest pain, often to the right shoulder radiation
    • acute pancreatitis, splenic infarction can accompany left lower chest pain, often left shoulder, esophageal spray door crack syndrome often in excessive drinking caused severe vomiting

Doctors do physical exam and run tests to diagnose the reason of chest pain. Most of the above diseases are not life-threating. But a few of them are severe enough to cost lives so everybody might benefit by learning the symptoms of them.

  • ACS – Acute Coronary Syndrome
    • ACS means the symptoms caused by reduced blood flow to the heart. ACS may be caused by unstable angina or a heart attack. ACS is a medical emergency, patients need to go to ER asap. The symptoms of ACS include:
  • Aortic dissection
    • Aortic dissection is uncommon but can be fatal. Aortic is the large vessel branching off the heart. The inner layer of the aorta tears, blood surges through the tear, causing the inner and middle layers of the aorta to dissect. When blood flow breaks through the outer layers of the aorta, it’s fatal. 
  • Acute pulmonary embolism
    • Acute pulmonary embolism means a sudden blockage in the arteries of lung, the blockage usually starts from a blood clot in a vein somewhere else that travels to the lung. Acute PE is life-threating , patients need treatment immediately. 
  • Tension pneumothorax
    • A tension pneumothorax means air is trapped in the pleural cavity under positive pressure, usually due to a lung laceration,  displacing mediastinal structures and compromising cardiopulmonary function. It’s life-threating. It’s an emergency in thoracic trauma.



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