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Chest pain can have many causes. Pain can come from the heart, lungs, gastrointestinal tract, muscles and bones of the chest wall, or abnormalities in nerve pain sensation. It is often difficult to distinguish one type of chest pain from another. There are many tests that can be done to help distinguish the different types of chest pain so that the correct treatment can be given. Because heart disease continues to be a major cause of death and disability, chest pain due to disease of the coronary arteries (arteries that supply the heart) is of particular concern. It is helpful to know the signs and symptoms that suggest cardiac (associated with the heart) chest pain (see below). Cardiac chest pain is called angina, is due to blockages or dysfunction in the coronary blood vessels (arteries and small artery branches called arterioles), and is usually related to physical exertion or stress. Not everyone has the same symptoms, and women often have atypical (different) symptoms compared with men. Risk factors for angina include high cholesterol, diabetes, smoking, high blood pressure, and a family history of coronary artery disease. The April 8, 2009, issue of JAMA includes an article about cardiac causes of chest pain.
Causes of chest pain
Heart disease, including coronary artery disease or pericarditis (inflammation of the tissue surrounding the heart)
Lung disease, including infections like pneumonia, pleurisy (inflammation of the lining surrounding the lungs and chest cavity), pulmonary emboli (blood clots) to the lungs, and asthma
Gastrointestinal reflux disease (GERD) due to acidic stomach contents flowing upward into the esophagus that may cause heartburn (burning pain in the chest) or difficulty swallowing
Musculoskeletal pain from the ribs or sternum (chest bone) and their attached muscles
Abnormalities in cardiac nerve pain sensation
Typical symptoms of cardiac chest pain
Chest pain that usually occurs with or is made worse by physical exertion or stress
Squeezing or pressure in the mid-chest region that may be associated with pain in the left arm or jaw
Chest pain associated with shortness of breath
Atypical symptoms of cardiac chest pain
Chest pain associated with nausea, lightheadedness, or dizziness
Fatigue or weakness occurring as a consequence of chest pain
Tests for chest pain
Blood tests for evidence of heart muscle damage or emboli to the lungs
Lung scan to detect any area with compromised airflow
Cardiac stress test to detect areas where there may be compromised blood flow to the heart muscle
Ultrasound of the heart (echocardiogram) to detect areas of the heart muscle or valves that may be weakened or damaged
Coronary angiogram (visualization of the heart's blood vessels) to detect blockages or dysfunction
For more information
National Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov/health/
American Heart Associationhttp://www.americanheart.org
To find this and other JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on cardiac stress testing was published in the October 15, 2008, issue; one on acute coronary syndromes in the July 8, 2008, issue; one on pulmonary embolism in the January 11, 2006, issue; one on pericarditis in the March 5, 2003, issue; and one on some of the differences in cardiac symptoms between women and men in the January 22, 2003, issue.
Source: National Heart, Lung, and Blood Institute
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
Hildreth CJ, Burke AE, Glass RM. Chest Pain. JAMA. 2009;301(14):1498. doi:10.1001/jama.301.14.1498
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