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Causes
By Mayo Clinic staff
Chest pain has many possible causes, all of which deserve medical attention.
Cardiac causes
- Heart attack. A heart attack is a result of a blood clot that's blocking blood flow to your heart muscle.
- Angina. Hard, thick, cholesterol-containing plaques can gradually build up on the inner walls of the arteries that carry blood to your heart. These plaques temporarily narrow the arteries and restrict the heart's blood supply, particularly during exertion. Restricted blood flow to your heart can cause recurrent episodes of chest pain — angina pectoris, or angina (pronounced an-JI-nuh or AN-juh-nuh).
- Aortic dissection. This life-threatening condition involves the main artery leading from your heart — your aorta. If the inner layers of this blood vessel separate, forcing blood flow between them, the result is sudden and tearing chest and back pain. Aortic dissection can result from a sharp blow to your chest or develop as a complication of uncontrolled high blood pressure.
- Coronary spasm. In coronary spasm, which is sometimes called Prinzmetal's angina, arteries that supply blood to the heart go into spasm, temporarily stopping blood flow. It occurs at rest and may coexist with coronary artery disease — a buildup of plaques in the coronary arteries.
- Pericarditis. This condition, an inflammation of the sac surrounding your heart, is short-lived and often related to a viral infection.
- Other heart-related conditions. Other heart problems — such as myocarditis, an inflammation of the heart that often is caused by viral infection — can cause chest pain. Certain types of heart muscle disorders, such as hypertrophic cardiomyopathy, also may cause chest pain.
Digestive causes
- Heartburn. Stomach acid that washes up from your stomach into the tube (esophagus) that runs from your throat to your stomach can cause heartburn — a painful, burning sensation behind your breastbone (sternum).
- Esophageal spasm. Disorders of the esophagus, the tube that runs from your throat to your stomach, can make swallowing difficult and even painful. One type is esophageal spasm, a condition that affects a small group of people with chest pain. When people with this condition swallow, the muscles that normally move food down the esophagus are uncoordinated. This results in painful muscle spasms.
- Hiatal hernia. In this condition, part of the stomach slides up above the diaphragm into the chest. This can cause chest pressure or pain, particularly after eating, as well as heartburn
- Achalasia (ak-uh-LA-zhuh). In this swallowing disorder, the valve in the lower esophagus doesn't open properly to allow food to enter your stomach. Instead, food backs up into the esophagus, causing pain.
- Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder (cholecystitis) or pancreas can cause acute abdominal pain that radiates to your chest.
Musculoskeletal causes
- Costochondritis. In this condition — also known as Tietze syndrome — the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed. The result is chest pain, often worsened when you push on your sternum or on the ribs near your sternum.
- Sore muscles. Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related chest pain.
- Injured ribs or pinched nerves. A bruised or broken rib, as well as a pinched nerve, can cause chest pain.
Respiratory causes
- Pulmonary embolism. This cause of chest pain occurs when a blood clot becomes lodged in a lung (pulmonary) artery, blocking blood flow to lung tissue. It's rare for this life-threatening condition to occur without preceding risk factors, such as recent surgery or immobilization.
- Pleurisy. This sharp, localized chest pain that's made worse when you inhale or cough occurs when the membrane that lines your chest cavity and covers your lungs becomes inflamed. Pleurisy may result from a wide variety of underlying conditions, including pneumonia and, rarely, autoimmune conditions, such as lupus. An autoimmune disease is one in which your body's immune system mistakenly attacks healthy tissue.
- Other lung conditions. A collapsed lung (pneumothorax), high blood pressure in the arteries carrying blood to the lungs (pulmonary hypertension) and asthma also can produce chest pain.
Other causes
- Panic attack. If you experience periods of intense fear accompanied by chest pain, rapid heartbeat, rapid breathing (hyperventilation), profuse sweating and shortness of breath, you may be experiencing a panic attack — a form of anxiety.
- Shingles. This infection of the nerves caused by the chickenpox virus can produce pain and a band of blisters from your back around to your chest wall.
- Cancer. Rarely, cancer involving the chest or cancer that has spread from another part of the body can cause chest pain.
References
- Meisel JL. Diagnostic approach to chest pain in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 20, 2009.
- Cannon CP, et al. Approach to the patient with chest pain. In: Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50052-2&uniq=159657875&isbn=978-1-4160-4106-1&sid=887271424. Accessed Sept. 20, 2009.
- Talley NJ. Functional gastrointestinal disorders: Irritable bowel syndrome, dyspepsia, and noncardiac chest pain. In: Goldman L, et al., eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/159657875-6/887271424/1492/531.html#4-u1.0-B978-1-4160-2805-5..50144-0--cesec86_5963. Accessed Sept. 20, 2009.
- What is angina? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina_WhatIs.html. Accessed Sept. 20, 2009.
- What is a heart attack? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_WhatIs.html. Accessed Sept. 20, 2009.
- Shingles disease: Questions and answers (herpes zoster). Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/shingles/dis-faqs.htm. Accessed Sept. 20, 2009.
- Mercier LR. Costochondritis. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/160691114-3/889462700/2088/162.html#4-u1.0-B978-0-323-05609-0..00012-5--sc0235_3245. Accessed Sept. 20, 2009.
- What are pleurisy and other disorders of the pleura. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_treatments.html. Accessed Sept. 20, 2009.
- Ferri FF. Angina pectoris. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/160691114-8/889471687/2088/48.html#4-u1.0-B978-0-323-05609-0..00010-1--s4220_886. Accessed Sept. 20, 2009.
- Heart attack, stroke and cardiac arrest warning signs. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3053. Accessed Sept. 20, 2009.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 25, 2009.
