Chest Pain

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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Daniel Lee Kulick, MD, FACC, FSCAI

Daniel Lee Kulick, MD, FACC, FSCAI

Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• There are many causes of chest pain, and while many are not serious, it may be difficult to distinguish among heart attack, pulmonary embolus or aortic dissection, and another diagnosis that is not life-threatening. For that reason, patients are routinely advised to seek medical care for most types of chest pain.
• While each cause of chest pain has a classic presentation, there are enough variations that it may take specific testing to come to a diagnosis. These tests will depend on the patient's presentation and the health care professional's index of suspicion as to what the diagnosis might be.
• Treatment for chest pain depends upon the cause.
• It is best to be safe. Always seek medical care for the assessment of chest pain.

Chest pain is one of the most common complaints that will bring a patient to the emergency department. Seeking immediate care may be lifesaving, and considerable public education has been undertaken to get patients to access medical care when chest pain strikes. While the patient may be worried about a heart attack, there are many other causes of pain in the chest that the health care professional will need to consider. Some diagnoses are life-threatening, while others are less dangerous.

Deciding the cause of chest pain is sometimes very difficult and may require blood tests, X-rays, CT scans and other tests to sort out the diagnosis. Often though, a careful history taken by the health care professional may be all that is needed to find the answer.

The following anatomic locations can all be potential sources of chest pain:

• the chest wall including the ribs, the muscles, and the skin;
• the back including the spine, the nerves, and the back muscles;
• the lung, the pleura (the lining of the lung), or the trachea;
• the heart including the pericardium (the sac that surrounds the heart);
• the aorta;
• the esophagus;
• the diaphragm, the flat muscle that separates the chest and abdominal cavities; and
• referred pain from the abdominal cavity including organs like the stomach, gallbladder, and pancreas, as well as irritation from the underside of the diaphragm due to infection, bleeding or other types of fluid.

There may be classic presentations of signs and symptoms for many diseases but they can also present atypically and there may also be significant overlap among the symptoms of each condition. Age, gender, and race can affect presentation and the health care professional must consider many variables before coming to a specific diagnosis.