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Chest Pain

Alternate Names

  • thoracic pain
  • chest wall pain

Definition

The chest is the area where the heart and lungs are located. These organs are protected by the rib cage and breastbone. Many different conditions can cause pain in the chest.

What is going on in the body?

Chest pain is a common complaint. In adults, it is often a cause for concern because it can signal a heart attack. However, many conditions ranging from a pulled muscle to pneumonia can also cause chest pain.

Risks

What are the causes and risks of the condition?

The many different causes for chest pain include:
  • heart pain. This may be due to stable angina, unstable angina or a heart attack. It also may be caused by myocarditis, inflammation of the heart muscle, or pericarditis, which is inflammation of the membranes lining the heart.
  • muscle strain in the chest. This can be brought on by lifting weights or other heavy items.
  • injury to the chest
  • bone or joint inflammation. This may include arthritis of the shoulder or spine, spinal disc problems in the neck, or costochondritis, an inflammation of the cartilage of the ribs.
  • damage, irritation or inflammation of the lungs. This may be caused by acute bronchitis, chronic bronchitis, pneumonia, pleurisy, lung cancer, or a punctured or ruptured lung.
  • blood vessel-related pain. This may be caused by aortic dissection or a blood clot known as a pulmonary embolus.
  • gastrointestinal pain. This may be caused by peptic ulcers, gastroesophageal reflux, gas pockets, irritable bowel syndrome, esophageal spasm, achalasia, or a tear or ulcer in the esophagus.
  • irritation of other organs in the abdomen. This may include gallbladder pain from cholecystitis, or pancreatitis.
  • herpes zoster. This painful condition results when the chickenpox virus reactivates in the nerve tracts, usually many years after a case of chickenpox.
  • emotional or psychological conditions such as anxiety and panic disorders
Other causes are also possible. In some cases, the cause is never found.

Prevention

What can be done to prevent the condition?

Prevention depends on the underlying cause of the chest pain. For example, avoiding overexertion can prevent muscle strain. In many cases chest pain cannot be prevented.

Diagnosed

How is the condition diagnosed?

Individuals can determine for themselves that they have chest pain. It is the healthcare professional's responsibility to find the cause of the pain. Sometimes the cause is obvious from a careful history and physical exam. Other times, further testing may be ordered based on the history and physical. Tests may include chest x-rays, blood and urine tests, and a heart tracing called an electrocardiogram (ECG).

Long Term Effects

What are the long-term effects of the condition?

The long-term effects are related to the underlying cause of the chest pain. For example, a heart attack may result in heart failure or death. The pain itself may cause discomfort severe enough prevent sleeping and other activities.

Other Risks

What are the risks to others?

Chest pain itself poses no risks to others. However, a person's chest pain may be due to a contagious infection such as pneumonia.

Treatments

What are the treatments for the condition?

Treatment is directed at the underlying cause of the chest pain. For example, a person with an infection such as pneumonia is treated with antibiotics. A person with aortic dissection may need emergency surgery.
Pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics, can be given to control pain. In some cases this is the only option since the underlying cause cannot be treated. An example of this situation would be a person with chest pain due to lung cancer.

Side Effects

What are the side effects of the treatments?

All medications have possible side effects. For example, nonsteroidal anti-inflammatory drugs can cause allergic reactions and stomach upset. Narcotics can cause nausea, constipation and allergic reactions. Other side effects are also possible, depending on the medication used. Surgery can be complicated by bleeding, infection or reactions to anesthesia or pain medications. More specific side effects depend on the surgery performed.

After Treatment

What happens after treatment for the condition?

If the underlying cause is treated, the chest pain will usually go away. Some people, such as those with arthritis, may need ongoing pain medication.

Monitor

How is the condition monitored?

Affected people can monitor their own chest pain and how well it responses to treatment. Chest pain can be a serious symptom and should not be ignored. Those with severe chest pain or known heart disease should go to the nearest hospital for evaluation of the pain.

Sources

Conn's Current Therapy, 2000, Rakel et al.

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

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