Chest Pain – Causes, Warning Signs, Serious Symptoms, Tests

Chest pain is considered as any pain felt between the collarbone (clavicle) and lower border of the ribcage. This includes pain emanating from the thoracic (chest) cavity and upper abdomen. Chest pain is often a cause for concern because it may indicate some disease of the heart, however, other important organs lie in the area which should also be considered in a case of chest pain.

Serious Signs and Warning Symptoms

If severe chest pain is accompanied by any change in breathing, particularly shortness of breath, dizziness, pale (pallor) to blue (cyanosis) colour of the skin and changes in the blood pressure, heart rate or breathing rates, immediate medical attention is required.

A person with a high risk of heart and lung disease also needs to be cautious. If you are are experiencing a crushing or stabbing chest pain which extends to the arm, sweating, and difficulty breathing, a heart attack needs to be excluded, especially in any person who is over 40 years of age, has high cholesterol and/or high blood pressure, smokes cigarettes and has a family history of heart disease.

Often acid reflux causes chest pain that closely resembles a heart attack but it is nevertheless essential to consult with a doctor to ensure that it is not serious.

Causes of Chest Pain

Depending on your age, medical history and the presence of any other serious signs and symptoms, heart and lung disorders should first be excluded as the cause of chest pain.

Heart and Blood Vessels

This may include injury, inflammation, reduced blood supply or death of heart muscle. Some of the causes :

  • Angina
  • Heart attack (myocardial infarction)
  • Heart valve dysfunction (prolapse, stenosis)
  • Myocarditis or pericarditis (inflammation of the heart muscle or sac lining the heart respectively)

Apart from the heart, there are major blood vessels carrying blood to and away from the heart. The most important vessel to consider in a case of chest pain is the aorta. Conditions like aortic aneurysm (ballooning wall) or dissection (tears) may cause severe chest pain.

Lungs and Airways

Pathology within the lungs or airways to the lungs may result in chest pain. This could include :

  • Asthma
  • Bronchitis
  • Cancer
  • Pleurisy
  • Pneumonia
  • Pneumothorax
  • Pulmonary embolism
  • Smoke inhalation
  • Tracheitis
  • Tuberculosis (TB)

Gastrointestinal and Abdominal

Many important structures of the gastrointestinal system may result in chest pain. The oesophagus (food pipe) runs through the thoracic cavity where it joins the stomach which lies in the upper abdomen. The diaphragm, a dome shaped muscle, separates the chest cavity from the abdominal cavity but in certain positions and when breathing, the upper abdominal contents rise fairly high up behind the ribcage.

Some of the causes of pain in the chest due to the gastrointestinal or upper abdominal structures includes :

  • Oesophagitis
  • Oesophageal cancer
  • Oesophageal rupture/spasm/tear
  • GORD (gastroesophageal reflux disease, heartburn, acid reflux)
  • Peptic ulcers (stomach ulcers and/or duodenal ulcers)
  • Mallory-Weiss tear
  • Hepatitis
  • Alcoholic liver disease
  • Pancreatitis
  • Gallstones
  • Kidney stones

Chest Wall

The chest wall is composed of the skin on the outside, muscles, bones and connective tissue lining the wall of the chest cavity. This may cause chest pain in the front or rear (back pain).

Some of the causes include :

  • Fractures of bones
  • Costochondritis – a common cause of breastbone pain
  • Arthritis, particularly osteoarthritis
  • Muscle spasm/strain
  • Shingles (herpes zoster)
  • Osteoporosis
  • Trauma to the chest wall due to a fall, assault or car accident injury

In women, the breast should also be considered as they can cause chest pain that may be referred to the deeper parts of the chest. Breast cancer and mastitis needs to be diagnosed early.

Other Causes of Chest Pain

  • Anxiety
  • Depression
  • Pinched nerve
  • Nerve inflammation or damage – this includes shingles
  • Tight clothing, especially bras in women

Tests to Diagnose Chest Pain

Depending on the presentation, your doctor may consider the following tests and investigative procedures :

  • Chest x-ray
  • Blood tests to check the levels of cardiac enzymes
  • ECG – this may include a stress ECG (exercise ECG) at a later stage if the initial ECG is normal.
  • Angiogram
  • Lung function tests
  • CT scan
  • MRI
  • Ultrasound of the abdomen