Chest pain is a common experience, but it can be frightening and represent a warning sign that something dangerous is happening in your body. In general, chest pain may originate from the musculoskeletal system, the digestive system, the lungs or the heart and circulatory system. Within each of these systems, there are specific common and uncommon causes of chest pain.
Musculoskeletal chest pain originates from the muscles, bones, joints and connective tissues of the outer chest wall. This kind of chest pain commonly results from chest trauma, such as from a car accident or fall. Chest muscle strain resulting from overuse also commonly causes chest pain. It often occurs if a typically inactive person engages in vigorous activity. Less commonly, musculoskeletal chest pain may result from an autoimmune condition like lupus. A flare-up can cause inflammation in the tissues connecting your ribs to your sternum.
Digestive System Conditions
While a number of digestive system conditions can cause chest pain, a common cause is heartburn, or acid reflux. Acid produced in the stomach backs up into the esophagus, which is located in the chest cavity near your back. The presence of the acid may cause burning, central chest pain. A less common cause of chest pain related to your digestive system is diffuse esophageal spasm, or DES. In this condition, the muscles of your esophagus go into uncoordinated spasm and cause acute, prolonged, sometimes severe chest pain. Because of the duration and sometimes severity of DES, your doctor will likely want to rule out other serious conditions such as a heart attack before making this diagnosis.
Many lung conditions can cause chest pain. Pneumonia, which is a viral or bacterial lung infection, is a common example. Other symptoms include shortness of breath, fever and cough. In many cases, the diagnosis is confirmed with a chest x-ray. A less common but serious lung disease that can cause chest pain is lung cancer. Smoking is a major risk factor. Pain related to lung cancer usually evolves gradually and may be associated with weight loss, fatigue, shortness of breath and coughing up blood.
Heart and Circulatory System Conditions
The most common heart condition causing chest pain is angina, which you can think of as a precursor to a heart attack. The pain is typically central or left-sided and may radiate to your jaw, arms, back or stomach. It may be associated with nausea and sweating, and worsen with activity. If you have any of these "anginal" symptoms, seek prompt medical attention.
Pulmonary embolism is the medical term for a blood clot that has traveled to your lungs. This is a less common cause of chest pain, which may increase with deep breathing. Other symptoms include coughing up blood, shortness of breath and swelling in one leg. An aortic aneurysm is a dilatation of the largest artery in your body, the aorta. If the aneurysm dissects, or tears, it can cause sudden, severe, tearing chest pain that radiates to the back.
All unexplained chest pain needs to be evaluated by a trained medical professional. However, there are some red flags that should prompt you to seek medical attention promptly. These include, but aren't limited to central chest pain radiating to your jaw, arms, back or stomach associated with nausea, vomiting or sweating, worse with exertion and better with rest; sudden-onset ripping or tearing chest pain that radiates to your back; and chest pain associated with a fever or shortness of breath, or made worse with deep inspiration.
- Tintinalli's Emergency Medicine: A Comprehensive Study Guide; Judith Tintinalli, et al.
- Current Diagnosis & Treatment in Family Medicine; Jeannette South-Paul, et al.
- American Family Physician: Diagnosing the Cause of Chest Pain