Causes of Chest Pain

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Most common

The most frequent cause of chest pain is acute coronary syndrome, which is triggered as a result of an obstruction of the heart arteries. Depending on the degree of obstruction of these arteries, the acute coronary syndrome receives a specific name:

Causes of chest pain

obstructed artery

When the obstruction is complete, it is called an ST-segment elevation myocardial infarction, and it constitutes 5-10% of the patients who consult due to chest pain.

Pain in the chest

When the obstruction is partial, two conditions can be produced, which are a non-ST-segment elevation myocardial infarction (15-20% of the patients) and unstable angina (10% of the patients). 

Cholesterol obstructing a vein

The arteries of the heart, in general, are obstructed due to atherosclerosis, which is a chronic inflammation of the arteries that give rise to the hardening and an accumulation of cholesterol (atheroma plaques) in their walls. When these plaques ulcerate, a clot is formed that can totally or partially obstruct the coronary artery. 

Obstruction of an artery that causes infarction

The rupture of an atheroma plaque causes the release of highly thrombogenic substances that induce platelet adhesion and aggregation due to the action of fibrinogen, with the formation of thrombin, and finally a platelet thrombus (clot). The formation of the clot causes an obstruction in the lumen of the vessel in which it is deposited. It reduces blood flow, either totally or partially, depending on the percentage of vessel obstruction, and consequently the provision of oxygen to the area. 

There are many diseases that can have chest pain as a clinical sign, some are serious, but the majority of patients (more than half) that consult for chest pain, it is due to some mild illness. 

Other diseases that can cause chest pain 

Cardiovascular diseases

  • Pericarditis. Inflammation of the membranes that cover the heart (pericardium). When the inflammation also affects the heart muscle, it is called myopericarditis. Very often the cause that produces this inflammation is not known, and it is called idiopathic pericarditis. On other occasions, this inflammation is secondary to an infection or a change in the immunity of the patient. The inflammation may give rise to an accumulation of fluid in the pericardial sac, which is very important in that it could lead to a cardiac tamponade (compression of the heart). 
  • Syndrome “X”. Produces pain similar to angina, but the patients do not have any lesions in the heart arteries, and it is not known how it produces the pain. It is a condition more common in women. 
  • Valve problems. People with valve diseases, such as mitral prolapse or narrowing (stenosis) of the aortic valve can experience chest pain similar to that of angina. 

Lungs diseases

  • Pneumonia. It consists of an infection of the lungs that shows up as chest pain, cough, and fever. 
  • Bronchitis. Inflammation of the airways, generally produced by an infection. 
  • Pleuritis. It is due to an inflammation of the membrane that surrounds the lung (pleura) and is usually produced as a result of an infection, generally by a virus, or as a complication of a pneumonia or a pulmonary embolism. 
  • Pain arising from the chest wall. A large number of conditions can cause the skin, muscles, bones, tendons, soft tissue, and cartilage of the chest wall to become painful. 
  • Musculoskeletal disorders. The physical activity that involves the chest muscles, especially when it is a new or exhausting activity, can produce muscle pain. The pain is generally prolonged (much more than the pain in acute coronary syndrome), often worse in a particular position, usually worsens with deep breathing, usually presents in a particular area, and when pressure is put on it the pain gets worse. Sometimes the cartilage that connects the ribs to the sternum is inflamed, causing pain. This is called costochondritis.
  • Diseases like arthritis or fibromyalgia can also produce chest pain. 
  • Herpes zoster. Affects the nerves of the chest wall and usually causes a very intense pain, sometimes accompanied by the presence of blisters in a particular area of the chest. 

Gastrointestinal diseases

  • Esophagitis. It is the inflammation or irritation of the oesophagus, the tube that goes from the mouth to the stomach. As the oesophagus and the heart are innervated by the same nerves, some cases of oesophageal pain can be confused with a myocardial infarction. The inflammation of the oesophagus can be produced by various causes, among them being gastroesophageal reflux or acidity. This is produced as a result of the acid content of the stomach passing back to the oesophagus. It is more likely to be produced by consuming alcohol, smoking, or due to the presence of repeated vomiting. 
  • Oesophageal spasm or oesophageal movement disorders. The muscles that surround the oesophagus contract abnormally and produce pain. 
  • Gastric ulcer. It is a lesion (ulceration) of the mucosa that covers the stomach or duodenum (the first part of the small intestine), often produced by a germ called Helicobacter pylori, but its appearance is also favoured by anti-inflammatory drugs. 
  • Pancreatitis. It is an inflammation of the pancreas (an organ situated in the abdomen behind the stomach). The most frequent cause of the inflammation are stones from the gallbladder, as well as consumption of alcohol, and less frequently from eating very fatty foods. 
  • Cholecystitis. It is an inflammation of the wall of the gallbladder, which is where the bile required for the digestion of foods accumulates. The most frequent cause of inflammation are the calculi (“stones”) that obstruct the normal emptying of the bile coming from the gallbladder. 
  • Anxiety or panic disorder. It is an involuntary anticipation reaction to stimuli (thoughts, situations, etc.) that are perceived as threats, and are accompanied by an unpleasant feeling or symptoms of tension, including those found in chest pain. 

 

Less common

Cardiac diseases

  • Aortic dissection. A tear is produced in the wall of the aortic artery that is usually highly associated with arterial hypertension, as well as diseases that weaken the walls of the blood vessels such as, for example, those called connective tissue disorders. 
  • Cardiac tamponade. The heart, like the lung, is covered by a membrane that is called the pericardium. When a large amount of fluid accumulates in the space between the heart and the pericardium (pericardial space), it compresses the heart from outside, which prevents it filling up with blood correctly. 

Lung diseases

  • Pulmonary embolism. In this case a pulmonary artery is obstructed by a clot that, generally, arises from the venous system of the legs. The obstruction of the pulmonary artery prevents the blood of the body from being oxygenated correctly. 
  • Tension pneumothorax. The lung is covered by two membranes, the visceral pleura (innermost, in contact with the lung) and the parietal pleura (outermost) and between them there is a virtual space that, when air enters (air that should not be there), often spontaneously, it causes compression of the lung, producing chest pain and shortness of breath. 
Substantiated information by:
Beatriz LópezUrgency Doctor — Emergency DepartmentEmilia VázquezNurse — Emergency Department

Published: 20 February 2018
Updated: 20 February 2018

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