Chest Pain

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Chest Pain Causes

Non-cardiac causes of chest pain include the following:

• Gastrointestinal Causes (reflux, ulcer)
• Musculoskeletal Causes
• Pulmonary Causes (pneumonia, pulmonary embolism, pneumothorax)
• Aortic Dissection
• Nerve Impingement
• Shingles

Gastrointestinal Causes
Pains originating from the digestive tract often can mimic heart pains. Acid produced in the stomach can sometimes reflux, or back up into the esophagus, the long tube that connects the mouth to the stomach. This can cause discomfort in the upper stomach or around the breastbone. Acid reflux can irritate and inflame the esophagus, a condition known as esophagitis. It occurs after a meal or when one lies down. One clue that acid reflux may be the cause of chest pain is that the discomfort often is relieved by the use of an antacid such as Maalox® or Mylanta®.

Another cause of pain originating from the digestive tract is an ulcer, an erosion of the lining of the stomach or duodenum, the first part of the small intestine. Ulcers can result from heavy alcohol consumption, or chronic use of nonsteroidal anti-inflammatory agents (NSAIDs), and pain medications, such as ibuprofen (Motrin®) and naproxen sodium (Aleve®, Naprosyn®). Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

Ulcers may also develop without a clear cause. As with acid reflux, the ulcer pain can cause discomfort in the upper abdomen, can be triggered by eating, and is sometimes relieved with antacids.

Musculoskeletal Causes
The chest contains many muscles, bones, tendons, and cartilage (the rubbery tissue that connects muscles and bones). Strains or sprains to any of these can cause chest pains. Chest pains associated with musculoskeletal injury are typically sharp and confined to a specific area of the chest. They may be brought on by movement of the chest and/or arms into certain positions, and often are relieved by changing position. These pains can be triggered by pushing on part of the chest and often become worse when taking a deep breath. These pains usually last only seconds, but can persist for days.

Pulmonary Causes
Pneumonia is an infection that develops in the lungs. It can lead to inflammation of the lung tissue or the tissue that surrounds the lung, a condition called pleuritis. Both conditions can cause chest pains. The pains of pneumonia and pleuritis are often made worse by deep breaths or coughing.

A rare but life-threatening condition that affects the lungs is pulmonary embolism, a blood clot that develops in a vein in the pelvis or legs. If part of the clot breaks free, it can travel through the bloodstream and into the lungs, where it may block the flow of blood in part of the lung. This can cause sudden chest pains and shortness of breath. Although blood clots can develop in people with no obvious risk factors, people considered to be at increased risk include those who remain immobile for long periods (e.g., bed-bound patients, people who sit through long-distance plane trips), cancer patients, and women who use birth control pills and smoke. Pulmonary embolism is a serious condition that requires immediate medical attention.

Another rare but potentially lethal lung condition that can cause chest pains is pneumothorax, which occurs when part or all of a lung collapses. Pneumothorax produces sharp chest pains and severe shortness of breath. As with other lung conditions, the pain may be felt more acutely with deep breaths, or may be made better or worse by assuming certain positions. Like pulmonary embolism, pneumothorax is a condition that requires immediate medical attention.

Aortic Dissection
A rare but often fatal condition associated with chest pain occurs when a tear develops in the wall of the aorta (the large blood vessel that carries blood from the heart to the head, arms, chest, abdomen, and legs). This condition, called aortic dissection, causes severe pains in the chest and/or back. Often described by survivors as the worst pain they ever experienced, the pain of aortic dissection may last hours, even days. Although it occurs most commonly in patients with high blood pressure, aortic dissection can strike anyone. It is a life-threatening condition that requires immediate diagnosis and treatment.

Nerve Impingement
The network of nerves that service all parts of the body originates in the spinal cord. The spinal cord runs through the spinal canal inside the spine or backbone. Smaller nerves branch off the spinal cord at various points along the neck and back and exit through openings along the spine. If one of these nerves becomes pinched or partially blocked where it exits the spine, pain can result. Nerve impingement also occurs when one or more of the soft discs that serve as shock absorbers between the bones of the spine become are damaged or "slip out of place." Impingement of the nerves by either of these processes can produce sharp "shooting" pain in the shoulders, arms, neck, or chest. These pains often are triggered by certain movements of the neck or arms.

Shingles
The chickenpox that most people experience as children is caused by a virus. Although the symptoms of chickenpox usually pass quickly, the virus itself can remain in the body, lying dormant for years. Occasionally, the virus can become "reactivated" and spread through a nerve to a specific area of the skin. When this occurs, it can cause pain, and later, the development of vesicles on the skin. This condition is called shingles.

Because the onset of discomfort or pain associated with shingles can precede the appearance of vesicles by several days, a person can experience pain in a certain area of the chest for several days before the cause becomes apparent. This discomfort often manifests as a dull, constant burning or pain in a localized area of the chest. Prompt recognition and diagnosis of shingles is important because medications now are available which, if administered early enough, can minimize the pain and shorten the duration of the attack.

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