Chest Pain


Chest pain is common presentation of cardiac disease, but can also be a manifestation of anxiety or disease of the lungs, the musculoskeletal or gastrointestinal system.

Common causes of chest pain:


• Myocardial ischaemia(angina)
• Myocardial infraction
• Myocarditis
• Pericarditis
• Mitral valve prolapse
• Aortic dissection
• Aortic aneurysm
• Oesophagitis
• Oesophageal spasm
• Mallory-Weiss syndrome
• Pulmonary embolism
• Malignancy
• Tracheitis


• Bronchospasm
• Pulmonary infraction
• Pneumonia
• Tuberculosis
• Malignancy
• Pneumothorax
• Connective tissue disorders
• Osteoarthritis
• Rib fracture/injury
• Intercostal muscle injury
• Costochondritis
• Herpes zoster
• Prolapsed intervertebral disc

Differential diagnosis:
Causes of chest pain range from non-serious to serious to life threatening.

• Acute coronary syndrome
o Unstable Angina Pectoris – requiring emergency medical treatment but not primary intervention as in a myocardial infarction.
o Myocardial infarction (“heart attack”)
• Aortic dissection
• Pericarditis and cardiac tamponade
• Arrhythmia – atrial fibrillation and a number of other arrhythmias can cause chest pain.
• Stable angina pectoris – this can be treated medically and although it warrants investigation, it is not an emergency in its strictest sense
• Myocarditis
• Mitral valve prolapse syndrome
• Aortic aneurysm
• Bronchitis
• Pulmonary embolism
• Pneumonia
• Hemothorax
• Pneumothorax and Tension pneumothorax
• Pleurisy – an inflammation which can cause painful respiration
• Tuberculosis
• Tracheitis
• Lung malignancy
• Gastroesophageal reflux disease (GERD) and other causes of heartburn
• Hiatus hernia
• Achalasia, nutcracker esophagus and other neuromuscular disorders of the esophagus
• Functional dyspepsia
Chest wall:
• Costochondritis or Tietze’s syndrome – a benign and harmless form of osteochondritis often mistaken for heart disease
• Spinal nerve problem
• Fibromyalgia
• Chest wall problems
• Radiculopathy
• Precordial catch syndrome – another benign and harmless form of a sharp, localised chest pain often mistaken for heart disease
• Breast conditions
• Herpes zoster commonly known as shingles
• Tuberculosis
• Osteoarthritis
• Bornholm disease

• Panic attack
• Anxiety
• Clinical depression
• Somatization disorder
• Hypochondria
• Hyperventilation syndrome often presents with chest pain and a tingling sensation of the fingertips and around the mouth
• Da costa’s syndrome
• Carbon monoxide poisoning
• Sarcoidosis
• Lead poisoning
• High abdominal pain may also mimic chest pain
• Prolapsed intervertebral disc
• Thoracic outlet syndrome
• Cardiovascular conditions:
• Cardiovascular conditions.

Management: In people with chest pain supplemental oxygen is not needed unless the oxygen saturations are less than 94% or there are signs of respiratory distress. Entonox is frequently used by EMS personnel in the prehospital environment. There is however little evidence about its effectiveness.


  1. Davidson’s Principle and Practice of Medicine, 21st edition.
  2. Wikipedia the free encyclopedia.

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