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Chest pain

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From MayoClinic.com


Chest pain has many possible causes, all of which deserve medical attention. The causes of chest pain fall into two major categories — cardiac and noncardiac causes.

Cardiac causes

  • Heart attack. A heart attack — a blood clot that's blocking blood flow to your heart muscle — can cause pressure, fullness, or a squeezing or crushing pain in your chest that lasts more than a few minutes. The pain may radiate to your back, neck, jaw, shoulders and arms, especially your left arm. Other signs and symptoms may include shortness of breath, sweating, dizziness and nausea. All, some or none of these may accompany your chest pain.
  • Angina. Fatty deposits can build up in the arteries that carry blood to your heart, narrowing them and temporarily restricting blood flow to your heart, especially during times of exertion. Restricted blood flow to your heart can cause recurrent episodes of chest pain — angina pectoris, or angina. Angina is often described as a pressure or tightness in the chest. It's usually brought on by physical or emotional stress. The pain usually goes away within minutes after you stop the stressful activity.
  • Other cardiac causes. Other problems that can cause chest pain include inflammation of the sac surrounding your heart (pericarditis), a short-lived condition often related to a viral infection. Pericarditis causes sharp, piercing and centralized chest pain. You may also have a fever and feel sick. A rare, life-threatening cause of chest pain called aortic dissection involves the main artery leading from your heart — your aorta. If the inner layers of this blood vessel separate, forcing blood flow between them, the result is sudden and tearing chest and back pain. Aortic dissection can result from a sharp blow to your chest or develop as a complication of uncontrolled high blood pressure. Coronary spasm, also known as Prinzmetal's angina, can cause varying degrees of chest discomfort. In coronary spasm, coronary arteries — arteries that supply blood to the heart — go into spasm, temporarily closing down blood flow to the heart. Spasm of the coronary arteries may occur spontaneously or be triggered by a stimulant, such as nicotine or caffeine. Coronary artery spasm, which tends to cause episodes of chest pain, can occur with activity or at rest. A spasm may even wake you from sleep. The condition may coexist with coronary artery disease — the buildup of fatty deposits in the coronary arteries. Other possible heart-related conditions that can cause chest pain are syndrome X and endothelial dysfunction.

Noncardiac causes

Many conditions unrelated to your heart can cause chest pain. These include:

  • Heartburn. Stomach acid that washes up from your stomach into the tube (esophagus) that runs from your mouth to your stomach can cause heartburn — a painful, burning sensation behind your breastbone (sternum). Often this feeling is accompanied by a sour taste and the sensation of food re-entering your mouth (regurgitation). Heartburn-related chest pain usually follows a meal and may last for hours. Signs and symptoms occur more frequently when you bend forward at the waist or lie down.
  • Panic attack. If you experience periods of intense fear accompanied by chest pain, rapid heartbeat, rapid breathing (hyperventilation), profuse sweating and shortness of breath, you may be experiencing a panic attack — a form of anxiety.
  • Pleurisy. Sharp, localized chest pain that's made worse when you inhale or cough may be caused by pleurisy. This condition occurs when the membrane that lines your chest cavity and covers your lungs becomes inflamed. Pleurisy may result from a wide variety of underlying conditions, including pneumonia and, rarely, autoimmune conditions such as lupus. An autoimmune disease is one in which your body's immune system mistakenly attacks healthy tissue.
  • Costochondritis. In this condition — also known as Tietze's syndrome — the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed. The pain from costochondritis may occur suddenly and be intense, leading you to assume you're having a heart attack. Yet the location of the pain is different. Costochondritis causes your chest to hurt when you push on your sternum or on the ribs near your sternum. Heart attack pain is usually more widespread, and the chest wall usually isn't tender.
  • Pulmonary embolism. This condition occurs when a blood clot becomes lodged in a lung artery, blocking blood flow to lung tissue. Symptoms of this life-threatening condition can include sudden, sharp chest pain that begins or worsens with a deep breath or cough. Other signs and symptoms can include shortness of breath, rapid heartbeat, anxiety and faintness. It's rare for pulmonary embolism to occur without preceding risk factors, such as recent surgery or immobilization.
  • Other lung conditions. A collapsed lung (pneumothorax), high blood pressure in the arteries carrying blood to the lungs (pulmonary hypertension) and asthma also can produce chest pain.
  • Sore muscles. Muscle-related chest pain tends to come on when you twist side to side or when you raise your arms. Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related chest pain.
  • Injured ribs or pinched nerves. A bruised or broken rib, as well as a pinched nerve, can cause chest pain that tends to be localized and sharp.
  • Swallowing disorders. Several disorders of the esophagus, the tube that runs from your mouth to your stomach, can make swallowing difficult and even painful. One type is esophageal spasm, a condition that affects a small group of people with chest pain. When people with this condition swallow, the muscles that normally move food down the esophagus are uncoordinated. This results in painful muscle spasms. Because esophageal spasms can be calmed with the medication nitroglycerin — which also rapidly relieves some heart-related pain — this condition is sometimes mistaken for a heart problem. Another swallowing disorder, which also affects a small group of people with chest pain, is achalasia. In this condition, the valve in the lower esophagus doesn't open properly to allow food to enter your stomach. Instead, food backs up into the esophagus, causing pain. Pain with swallowing also can accompany heartburn.
  • Shingles. This infection of nerves caused by the chickenpox virus can produce pain and a band of blisters on your back around to your chest wall. This sharp, burning pain may begin several hours to a day or so before blisters appear.
  • Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder (cholecystitis) or pancreas can cause acute abdominal pain that radiates to your chest.
  • Cancer. Rarely, cancer involving the chest or cancer that has spread from another part of the body can cause chest pain.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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