Chest pain causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2], Kiran Singh, M.D. [3],Nuha Al-Howthi, MD[4]

Overview

Life threatening causes of chest pain include myocardial infarction, aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture. Other common causes of chest pain include GERD, chest wall tenderness, achalasia, pneumonia, and anxiety.

Causes

Considerations for older patients: older patients presenting with chest pain require a more extensive workup for alternative diagnoses associated with chest pain, besides acute coronary syndromes. Increased age is a very important risk factor for comorbidities that predispose to other causes of chest pain.

Life Threatening Causes

• Aortic dissection
• Esophageal rupture
• Myocardial infarction
• Myocarditis
• Pulmonary embolism
• Tension pneumothorax

Common Causes

• Achalasia
• Anxiety
• Costochondritis
• Depression
• Gastroesophageal reflux disease
• Pancreatitis
• Panic disorder
• Pericarditis
• Pneumonia
• Precordial catch
• Unstable angina

Causes by Organ System

Cardiovascular	Accelerated hypertension, acute aortic dissection, acute coronary syndrome, aortic aneurysm, aortic coarctation, aortic Stenosis, arryhthmias, atheroma, atrial fibrillation, atrial flutter, atrial myxoma, Bergman syndrome, Bernheim syndrome, Bland-White-Garland Syndrome, cardiac syndrome X, cardiomyopathy, cardiopulmonary resuscitation, chronic stable angina, cor pulmonale, coronary artery dissection, coronary heart disease, dilated cardiomyopathy, Dressler's syndrome, Eisenmenger syndrome, familial hypercholesterolemia, heart attack, Heller-dohle disease, hypertrophic cardiomyopathy, ischemic heart disease, isolated coronary artery anomalies, Kawasaki disease, left ventricular hypertrophy, mitral valve prolapse, myocardial infarction myocarditis, non ST elevation MI, pericardial tamponade, pericarditis, prinzmetal angina, pulmonary embolism, ST elevation MI, stress cardiomyopathy, Takotsubos cardiomyopathy, unstable angina
Chemical/Poisoning	1,1-Dimethyl hydrazine, 1,2-Dibromo-3-chloropropane, acetonitrile, acrylonitrile, arsenic dioxide, arsenicals, carbon monoxide, lead
Dental	No underlying causes
Dermatologic	Herpes zoster, SAPHO syndrome
Drug Side Effect	Adenosine, amonafide, amphetamine, aztreonam, bedaquiline fumarate, cidofovir, clomifene, corticorelin, cytarabine, cytosine arabinoside syndromedesmopressin, dimercaprol, disulfiram, dolasetron mesylate, dornase Alfa, febuxostat, fesoterodine, gemeprost, glatiramer acetate, idarubicin hydrochloride, indomethacin, interferon gamma, iodixanol, ivacaftor, latanoprost, levalbuterol, megestrol, meropenem,nylidrin, methacholine, nabilone, naratriptan, Oprelvekin, phenylephrine, porfimer, porfimer,regadenoson, ramucirumab, repaglinide, repaglinide and metformin hydrochloride, rifaximin, rizatriptan, sargramostim, sertraline, sumatriptan, taliglucerase alfa, tamsulosin, thalidomide, tiagabine, tolmetin, topiramate, travoprost, triazolam, trospium, zolmitriptan, zonisamide
Ear Nose Throat	Retropharyngeal abscess
Endocrine	Acromegaly, conn's Syndrome, gynecomastia, hyperthyroidism, hypothyroidism
Environmental	No underlying causes
Gastroenterologic	Abdominal distension, achalasia, Barret’s esophagus, Bergman syndrome, cholecystitis, cholelithiasis, diverticulitis, duodenitis, esophageal cyst, esophageal rupture, esophageal spasm, esophagitis, foreign body, gallbladder disease, gas, gastritis,gastroesophageal reflux (GERD), hiatus hernia, impacted stone, irritable bowel disease, liver abscess, Mallory-Weiss Syndrome, neoplasm,nutcracker's esophagus, pancreatitis, peptic ulcer disease, perforated ulcer, peritonitis, Plummer-Vinson Syndrome, pneumoperitoneum rumination disorder, splenic enlargement, splenic infarction, subdiaphragmatic abcsess, subphrenic abscess, Whipple's Disease
Genetic	Fabry disease , familial hypercholesterolemia, familial mediterranean fever, recurrent hereditary polyserositis
Hematologic	Acute intermittent porphyria, autoimmune hemolytic anemia, blood transfusion complication, langerhans' cell histiocytosis , lymphangiomyomatosis, pulmonary embolism, sickle cell anemia
Iatrogenic	No underlying causes
Infectious Disease	Alveolar hydatid disease, ankylostomiasis, Bornholm disease, chagas disease, cryptococcosis, hepatitis, herpes zoster, Herpes zoster,Actinomyces, histoplasmosis, HIV infection, lassa fever, Legionnaires' disease, mycoplasma pneumonia, peritonitis, pneumonia, Pott's Disease, Subdiaphragmatic abcsess, trichinella spiralis
Musculoskeletal/Orthopedic	SAPHO syndrome, Ankylosing spondylitis , Bechterew's Disease, chest wall pain syndrome, chondritis, costosternal tendinitis, connective tissue disease, chondritis, costochondritis, costochondrol tendinitis, degenerative changes of cervical spine, fibromyalgia, fractured rib, intercostal muscle spasm, intercostal neuralgia, interstitial fibrosis, muscle strain or spasm, musculoskeletal pain , myofascial pain, myostitis, Pectus excavatum, periostitis, precordial catch syndrome shoulder bursitis, radiculitis, rib pain, SAPHO syndrome, shoulder tendinitis, Soft tissue sarcoma or tumor, sternoclavicular arthritis, strain of pectoralis muscle, thoracic outlet syndrome, Tietze's syndrome, vertebrogenic thoracic pain, xiphodynia
Neurologic	Acute spinal cord injury, migraine headache, neuritis, shingles, tabes dorsalis
Nutritional/Metabolic	Glycogenosis
Obstetric/Gynecologic	Mastalgia, Mondor's disease, thelarche
Oncologic	Bone tumor, bronchial carcinoma, bronchogenic carcinoma, liver cancer, langerhans' cell histiocytosis, mediastinal tumor, mesothelioma, metastatic tumor, neurofibroma, pheochromocytoma, pleural fibroma
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	Affective disorders (e.g., anxiety disorders, chronic fatigue syndrome, Da costa's syndrome, depression), fabricated or induced illness, factitious disorders (e.g. münchausen syndrome, fixed delusions) hyperventilation syndrome, functional disorders, hospital addiction syndrome, hypochondria, panic attack, somatization disorder, somatoform disorders, thought disorders
Pulmonary	Alveolar hydatid disease anthracosis, asbestosis, asthma, barotrauma, bronchial carcinoma, bronchiectasis, bronchitis, bronchogenic carcinoma, bronchogenic cyst, chronic cough, chronic obstructive pulmonary disease (COPD), cor pulmonale, empyema, foreign body aspiration Goodpasture's syndrome, hemothorax, hyperventilation, Interstitial lung disease, laryngotracheitis, legionnaires' disease, lung abscess, lung Cancer, lymphoma, mediastinitis, mesothelioma, mycoplasma pneumonia, pleural effusion, pleural empyema, pleural fibroma, pleuritis,pleurodynia, pneumoconiosis, pneumomediastinum, pneumonia, pneumothorax, pulmonary embolism, pulmonary infarction, respiratory alkalosis,silicosis, tension pneumothorax, thymoma, tracheitis, tracheoesophageal abscess, tuberculosis, wegner's granulomatosis
Renal/Electrolyte	Goodpasture's syndrome , Wegner's granulomatosis
Rheumatology/Immunology/Allergy	Atopy, autoimmune hemolytic anemia , chondritis, connective tissue disease, costochondritis, degenerative changes of cervical spine, familial mediterranean fever, fibromyalgia, Goodpasture's syndrome, langerhans' cell histiocytosis, recurrent hereditary polyserositis, Wegner's granulomatosis
Sexual	No underlying causes
Trauma	Acute spinal cord injury, barotrauma, chest wall injuries
Urologic	No underlying causes
Miscellaneous	Air embolism,Chinese restaurant syndrome, decompression sickness , Idiopathic