Chest pain has many possible causes, all of which deserve medical attention.

Cardiac causes

 Heart attack. A heart attack is a result of a blood clot that's blocking blood flow to your heart
muscle.

 Angina. Hard, thick, cholesterol-containing plaques can gradually build up on the inner walls of
the arteries that carry blood to your heart. These plaques temporarily narrow the arteries and
restrict the heart's blood supply, particularly during exertion. Restricted blood flow to your heart
can cause recurrent episodes of chest pain — angina pectoris, or angina (pronounced an-JI-nuh or
AN-juh-nuh).

 Aortic dissection. This life-threatening condition 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. In coronary spasm, which is sometimes called Prinzmetal's angina, arteries
that supply blood to the heart go into spasm, temporarily stopping blood flow. It occurs at rest and
may coexist with coronary artery disease — a buildup of plaques in the coronary arteries.

 Pericarditis. This condition, an inflammation of the sac surrounding your heart, is short-lived and
often related to a viral infection.

 Other heart-related conditions. Other heart problems — such as myocarditis, an inflammation

of the heart that often is caused by viral infection — can cause chest pain. Certain types of heart
muscle disorders, such as hypertrophic cardiomyopathy, also may cause chest pain.

Digestive causes

 Heartburn. Stomach acid that washes up from your stomach into the tube (esophagus) that runs
from your throat to your stomach can cause heartburn — a painful, burning sensation behind your
breastbone (sternum).

 Esophageal spasm. Disorders of the esophagus, the tube that runs from your throat 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.

 Hiatal hernia. In this condition, part of the stomach slides up above the diaphragm into the chest.
This can cause chest pressure or pain, particularly after eating, as well as heartburn
 Achalasia (ak-uh-LA-zhuh). In this swallowing disorder, 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.

 Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder

(cholecystitis) or pancreas can cause acute abdominal pain that radiates to your chest.

Musculoskeletal causes

 Costochondritis. In this condition — also known as Tietze syndrome — the cartilage of your rib
cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed. The
result is chest pain, often worsened when you push on your sternum or on the ribs near your
sternum.

 Sore muscles. 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.

Respiratory causes

 Pulmonary embolism. This cause of chest pain occurs when a blood clot becomes lodged in a
lung (pulmonary) artery, blocking blood flow to lung tissue. It's rare for this life-threatening
condition to occur without preceding risk factors, such as recent surgery or immobilization.

 Pleurisy. This sharp, localized chest pain that's made worse when you inhale or cough 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.

 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.

Other causes

 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.

 Shingles. This infection of the nerves caused by the chickenpox virus can produce pain and a band
of blisters from your back around to your chest wall.
 Cancer. Rarely, cancer involving the chest or cancer that has spread from another part of the
body can cause chest pain.

 Electrocardiogram (ECG). This test can help doctors diagnose a heart attack as well as other
heart problems. It records the electrical activity of your heart through electrodes attached to your
skin. Heart rate and rhythm and the electrical impulses going through your heart are recorded as
waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct
electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.

 Blood tests. Your doctor may order blood tests to check for increased levels of certain enzymes
normally found in heart muscle. Damage to heart cells from a heart attack may allow these
enzymes to leak, over a period of hours, into your blood.

 Chest X-ray. An X-ray of your chest allows doctors to check the condition of your lungs and the
size and shape of your heart and major blood vessels. Doctors can also use a chest X-ray to check
for tumors in the chest and to look for lung problems that can cause chest pain, such as pneumonia
or pneumothorax.

 Stress tests. These measure how your heart and blood vessels respond to exertion, which may
indicate if your pain is related to your heart. There are many kinds of stress tests. You may be
asked to walk on a treadmill or pedal a stationary bike while hooked up to an ECG. Or you may be
given a drug intravenously to stimulate your heart in a way similar to exercise. Stress tests may be
combined with imaging of the heart using ultrasound (echocardiography) or radioactive material
(nuclear scan).

 Echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart.
This image can help doctors identify heart problems.

 Coronary catheterization (angiogram). This test helps doctors identify individual arteries to
your heart that may be narrowed or blocked. A liquid dye is injected into the arteries of your heart
through a catheter — a long, thin tube that's fed through an artery, usually in your groin, to arteries
in your heart. As the dye fills your arteries, they become visible on X-ray and video.

 Computerized tomography (including CT scan, CT coronary calcification scan or CT

coronary angiogram). Different types of CT scans can be used to check your heart arteries for
signs of calcium, which indicate that atherosclerotic plaques may be accumulating and blocking
arteries supplying your heart. CT scans can also be done with dye to look directly at your heart
arteries.

 Magnetic resonance imaging (MRI). MRI is an imaging technique that uses magnetic fields and
radio waves to create cross-sectional images of your body. MRI of the heart is sometimes done to
look for evidence of heart damage or inflammation (myocarditis).

 Endoscopy. In this test a thin, flexible instrument attached to a camera is passed down your
throat, allowing doctors to view your esophagus and stomach and check for gastroesophageal
problems that can cause chest pain.
Many types of chest pain may at first seem related to heart problems. But often, after careful
evaluation, doctors can distinguish the symptoms of noncardiac chest pain from the pain caused by a
heart condition.

Cardiac causes
If it appears that heart problems are the cause of your chest pain, your doctor may give you
medications such as:
 Aspirin. Aspirin inhibits blood clotting, helping to maintain blood flow through narrowed heart
arteries. When taken during a heart attack, aspirin can significantly decrease death rates. You may
be asked to chew the aspirin to hasten its absorption. Aspirin is recommended for most people who
have had a heart attack.

 Nitroglycerin. This medication for treating angina temporarily widens narrowed blood vessels,
improving blood flow to and from your heart.

 Beta blockers. These drugs help relax your heart muscle, slow your heart rate and decrease your
blood pressure, which decreases the demand on your heart. These medications help limit the
amount of damage during a heart attack and prevent a second heart attack.

 Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking
blood flow to your heart. These drugs are most effective when taken within an hour after
symptoms of a heart attack begin.

 Ranolazine (Ranexa). This is a relatively new drug for treating chronic angina. It's used only
when other anti-anginal drugs haven't worked because it can cause a heart problem known as QT
prolongation, which can increase your risk of heart rhythm problems. It should be used with other
angina medications, such as calcium channel blockers, beta blockers or nitroglycerin.

 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers

(ARBs). These drugs allow blood to flow from your heart more easily. Your doctor may prescribe
ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your
heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart
attack.

 Calcium channel blockers. When treating coronary artery spasm, doctors sometimes use heart
medications such as calcium channel blockers to relax the coronary arteries and prevent spasm.

Heart attack treatments

If it's clear you're having a heart attack, you may be treated with clotbusting drugs or undergo a
surgical procedure such as:

 Angioplasty and stenting. During an angioplasty — also called a percutaneous coronary

intervention (PCI) — doctors insert a catheter with a special balloon into a blocked coronary artery.
The balloon is inflated to open up the artery and restore blood flow to your heart. Then, a small
wire mesh coil (stent) is usually inserted to keep the artery open. Many people will go straight
from the emergency room to the catheterization laboratory to have angioplasty performed as
quickly as possible.

 Coronary bypass surgery. This procedure creates an alternative route for blood to go around a
blocked coronary artery.
Angina treatment
Doctors usually first treat angina with medication. You'll likely start receiving medication in the
emergency room, including aspirin, nitroglycerin, beta blockers and blood thinners.

If you have unstable angina — chest pain while you're at rest — you may need immediate coronary
catheterization followed by angioplasty and stenting. In some cases, you may need coronary bypass
surgery.

Treatment for other cardiovascular conditions

Other heart and lung conditions can be treated initially in the emergency room. If it's clear you're
experiencing a pulmonary embolism, you'll likely be treated with emergency blood-thinning
medications, sometimes including clotbusting medications (thrombolytics).

Aortic dissection often requires emergency surgery.

Noncardiac causes
If emergency room doctors determine you're out of immediate danger, you may be referred to your
own physician or a specialist for further evaluation. Treatments for noncardiac causes of chest pain
depend on the type of problem. These problems and their treatments include:

 Heartburn. If your symptoms suggest heartburn, you'll likely need to take an over-the-counter or
prescription-strength stomach acid blocker or antacid in the emergency room. Most episodes of
heartburn are isolated events caused by overeating or by eating fatty foods.

If you experience frequent heartburn (at least one episode a week), your doctor or a doctor who
specializes in stomach and intestinal problems (gastroenterologist) may ask you to undergo more
tests. Left untreated, chronic, frequent heartburn can occasionally lead to scarring and narrowing of
your esophagus. Treatment for chronic heartburn may include dietary modifications, antacids, acid
blockers or other prescription medications and, in some cases, surgery.

 Panic attack. This anxiety-related cause of chest pain can be treated with prescription anti-
anxiety medications, relaxation techniques and counseling to find out what may be triggering your
attacks. Panic attacks are often mistaken for heart attacks, and many people are seen in
emergency rooms for this problem. But once your condition is diagnosed, you can be referred for
treatment to help you gain control over these attacks.

 Pleurisy. This inflammation of the pleura, the membrane that lines your chest cavity and covers
your lungs, may result from a variety of conditions, including pneumonia and, rarely, autoimmune
conditions such as lupus. Your doctor will want to identify and treat the underlying disease that
caused pleurisy. Over-the-counter pain relievers can help minimize the pain until the inflammation
subsides.
 Costochondritis. Treatment for this inflammation of the cartilage of your rib cage is generally
rest, heat and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others).

 Sore muscles, injured ribs or pinched nerves. Chest pain from injured ribs, pinched nerves
and sore chest muscles improves with time and self-care measures recommended by your doctor.

 Swallowing disorders. These disorders have many causes, which can usually be treated with
medications, minor surgery or endoscopic techniques. You'll probably be referred to a
gastroenterologist for evaluation and treatment.

 Shingles. Treatment with acyclovir (Zovirax) or a similar antiviral medication is best started as
quickly as possible, preferably within 24 hours from the onset of pain or burning, and before the
appearance of blisters. Doctors use other treatments, such as analgesics and antihistamines, to
control symptoms such as pain and itching.

 Gallbladder or pancreas problems. You may need surgery to treat an inflamed gallbladder or
pancreas that's causing pain to radiate from your abdomen into your chest.

Chest pain can be one of the most difficult symptoms to interpret. But spending time in the ER having
your chest pain evaluated can bring you peace of mind, and may even save your life.

Tests and diagnosis

References
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Nov. 13, 2009

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