Information on Chest Pain

Chest pain is a frequent complaint in general and it is one of the frequent causes of visit to physicians. Elucidation of the cause of chest pain is one of the key tasks of physicians and this symptom is responsible for many cardiac consultations. Chest pain is critical to recognize as it may originate not in the heart but also in a variety of non-cardiac intrathoracic (inside the chest) structures and organs and the chest wall itself. Sometimes diseases of upper abdominal organs can give rise to chest pain.

Factitious or hysterical chest pain may also occur in the chest. Patients having chest pain will be given immediate attention by relatives and doctors and so many a times malingering of chest pain is frequent to drag attention of the relatives. Sometimes chest pain can be political in nature to avoid the duties and punishment etc.

A wide variety of laboratory tests are available to aid the diagnosis of chest pain. There is temptation in cardiology as in many other areas of medicines to carry out expensive, uncomfortable, and occasionally hazardous procedures when a detailed and thoughtful historic and physical examination is sufficient. Obviously it is undesirable to subject a patient to the unnecessary risk and expenses inherent in many specialized tests when a diagnosis can be made on the basis of an adequate clinical examination or when management will not be altered significantly as a result of these tests. For example when a patient is not fit or not willing for Bypass surgery then why angiography should be done.

The patients should describe the location of pain, radiation and character of pain. What causes and relieves the pain, time relationship including frequency and patter of recurrence of pain, the setting in which it occurs and associated symptoms.

1. Angina Pectoris: It is a discomfort in the chest or adjacent areas associated with decreased supply of blood/oxygen to heart muscles but without death of heart muscles. Clinical Examination: E.C.G. Echocardiography, Coronary Angiography.


2. Myocardial Infarction (Heart Attack): Pain is similar to Angina Pectoris but more severe and prolonged one more than 30 minutes. Not relieved by rest or sorbitrate. It may be accompanied by shortness of breath, sweating, nausea, vomiting, diarrhea, profound weakness, dizziness, palpitation and sense or impending doom. In some patients especially in diabetics and in elderly, there will not be chest pain but they present the above symptoms (Silent M.I.). Clinical Examination: E.C.G. Lab Enzymes C.P.K. MB, Troponin, L.d.H. SGOT, 2D Echo, Angio – etc.


3. Esophageal pain and peptic ulcer pain: It mimics anginal pain. It can cause burn, indigestion and gaseous belching similar to anginal pain. It may be associated with meals or during swallowing. Not associated with exercise. The pain is often relieved by sorbitrate but takes longer time, but gives an impression of cardiac pain. Pain will be marked recumbent posture. Clinic Examination: Endoscope, Pouring mild acid in esophagus with Ryle’s tube.


4. Pain due to Gall Bladder: It is common in above forty years fatty and fertile females. Pain lasts for 2 to 4 hours. Mostly right lower side of the chest with tenderness. Pain may be referred to back or to should. Dyspepsia, Indigestion, flatulence, fatty meal intolerance. Clinic examination: Ultrasound, X – Ray.


5. Splenic Flexure Syndrome: Distending gas in large intestine. It may mimic heart pain. Relief of symptoms often follows a bowel movement or passing gas.


6. Pain due to chest wall: (Teitz Syndrome) Local pain and tenderness in the anterior chest wall with swelling or rib joint. Resembles anginal pain.


7. Cervical Spondylitis: Mimics anginal pain. Pain may be related to the motion of neck. Pain in sensitive areas may be noted. Clinical Examination: X – Ray Cervical Spine.


8. Chest pain due to Herpes Zoster: It may involve left side of the chest, mimics heart attack. Persistence of pain to a particular area and appearance of blister allows recognition.


9. Psychogenic pain and Malingering: (Da-cost a Syndrome) Pain mostly at apex and sharp. Patient points the site of pain, which is unusual in heart pain help in diagnosis. If pain is localized with finger, it rules out cardiac pain. Clinical Examination: Observation, E.C.G.T.M.T., Echo – Cardiograph.


10. Chest pain due to Mitral Valve Prolapsed: Very common in young patients especially in females. Pain is due to stretching of leaflets. Mimics anginal pain. Clinical Examination: E.C.G., 2D Echo.


11. Pulmonary Embolism: Usually associated with chest pain. Seen in obese people after fractures or after surgery or deliveries or during prolonged decumbency. Patient also brings out blood with cough. Clinical Examination: X – Ray, Chest Pulmonary Angiography, Ventilation / Perfusion scan.


12. Pleural Pain: Associated with fever, cough tenderness. Pain will be sharp, stabbing and localized and increase with cough and deep respiration. Clinical Examination: X- Ray Chest.


13. Other causes of chest pain are liver Abscess and Pericarditis etc.

Disclaimer - This information is not intended to replace the advice of a doctor. We disclaim any liability for the decisions you make based on this information. Before taking any decisions please talk to your doctor. We are not responsible for any damage that might result from taking decision based on this website.