Materiały źródłowe

• #1 Chest Pain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470557/

  Chest pain is a common complaint and encompasses a broad differential diagnosis that includes several life-threatening causes. A workup must focus on ruling out serious pathology before a clinician considers more benign causes. […] Chest pain is a common complaint and encompasses a broad differential diagnosis that includes several life-threatening causes. A workup must focus on ruling out serious pathology before a physician considers more benign causes. […] It sometimes is helpful to consider the different etiologies of pain. […] Common descriptors of visceral pain are dull, deep, pressure, and squeezing. […] Ischemic heart pain, for example, may refer to the left or right shoulder, jaw, or left arm. […] Symptoms like nausea and vomiting may also be a sign of visceral pain. […] Other common causes of chest pain with approximate percent occurrence in patients presenting to the emergency department with chest pain include gastrointestinal reflux disease, musculoskeletal causes, pneumonia/pleuritis, herpes zoster, and pericarditis. […] Once you have thoroughly ruled out life-threatening causes, move on to other possibilities. […] Gastroesophageal reflux disease (GERD) is a common cause of chest pain so ask about any reflux symptoms. […] It is, therefore, important to rule out ACS before assigning GERD as a final diagnosis.

• #2 Causes of Chest Pain: Signs and Symptoms, Complications

  https://www.medicinenet.com/causes_of_chest_pain_signs_and_symptoms/article.htm

  Causes of Chest Pain Chest pain may be caused by many conditions. […] Chest pain may arise as a result of problems with any of the structures located between the neck and the upper part of the abdomen. […] The following is a list of tissues and organs that when the disease is present may result in chest pain: Heart, Lungs, Chest muscles, Bones (ribs, sternum, and clavicles for example), Esophagus, Nerves, Stomach, Pancreas, Gastrointestinal tract, Skin. […] Some causes of chest pain are medical emergencies (most heart problems, for example) and need to be evaluated immediately by medical caregivers. […] The following are 33 potential causes of chest pain stemming from all sorts of different conditions — each discussed in detail in this article. […] Heart problems are a common cause of chest pain.

• #3 Acute Chest Pain in Adults: Outpatient Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1215/p721.html

  Approximately 1% of primary care office visits are for chest pain, and 2% to 4% of these patients will have unstable angina or myocardial infarction. […] A combination of age, sex, and type of chest pain can predict the likelihood of coronary artery disease as the cause of chest pain. […] The most common causes of chest pain in the primary care population are chest wall pain (20% to 50%), reflux esophagitis (10% to 20%), and costochondritis (13%). […] Other potential factors include pulmonary etiologies (pneumonia, pulmonary embolism [PE]), psychological etiologies (panic disorder), and nonischemic cardiovascular disorders (congestive heart failure, thoracic aortic dissection). […] Differentiating ischemic from nonischemic causes is often challenging because patients with ischemic chest pain may appear well.

• #4 Outpatient evaluation of the adult with chest pain – UpToDate

  https://www.uptodate.com/contents/outpatient-evaluation-of-the-adult-with-chest-pain

  Patients who present to the office with chest pain are a diagnostic challenge given the wide array of possible etiologies, including a potentially life-threatening condition. Approximately 1 percent of all ambulatory visits in primary care are for chest pain. Cardiac disease is the leading cause of death in the United States, yet only 2 to 4 percent of patients presenting to a primary care office with chest pain will have unstable angina or an acute myocardial infarction. The most common causes of chest pain in the primary care population are chest wall pain (20 to 50 percent), reflux esophagitis (10 to 20 percent), and costochondritis (13 percent). […] The causes of chest pain range from life-threatening conditions to those that are relatively benign. […] Acute coronary syndrome – Patients with acute coronary syndrome (ACS) have anginal symptoms at rest, new-onset angina, or progressive angina (more frequent, longer in duration, or occurring with less exertion than previously).

• #5 Acute Chest Pain in Adults: Outpatient Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1215/p721.html

  Chest wall pain is the most common cause of chest pain in the outpatient setting, accounting for 33% to 50% of chest pain. […] Often considered a subset of chest wall pain, costochondritis is a self-limited condition characterized by pain that is reproducible with palpation in the parasternal costochondral joints. […] Classic symptoms of gastroesophageal reflux disease (GERD) include a burning retrosternal pain, acid regurgitation, and a sour or bitter taste in the mouth. […] Panic disorder and anxiety states are common. One in four people with a panic attack will have chest pain and shortness of breath. […] Pericarditis manifests as a clinical triad of pleuritic chest pain, a pericardial friction rub, and diffuse ECG STT-wave changes often preceded by a viral illness. […] Common symptoms of pneumonia include fever, chills, productive cough, and pleuritic chest pain. […] Most patients with heart failure present with dyspnea on exertion, although some will present with chest pain. […] Diagnosing PE in the office is challenging because its presentation is highly variable. […] Patients with acute thoracic aortic dissection may present with chest or back pain.

• #6 Diagnosing the Cause of Chest Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1115/p2012.html

  Chest pain presents a diagnostic challenge in outpatient family medicine. Noncardiac causes are common, but it is important not to overlook serious conditions such as an acute coronary syndrome, pulmonary embolism, or pneumonia. […] Chest pain is the chief complaint in about 1 to 2 percent of out-patient visits, and although the cause is often noncardiac, heart disease remains the leading cause of death in the United States. […] The epidemiology of chest pain differs markedly between outpatient and emergency settings. Cardiovascular conditions such as myocardial infarction (MI), angina, pulmonary embolism (PE), and heart failure are found in more than 50 percent of patients presenting to the emergency department with chest pain, but the most common causes of chest pain seen in outpatient primary care are musculoskeletal conditions, gastrointestinal disease, stable coronary artery disease (CAD), panic disorder or other psychiatric conditions, and pulmonary disease.

• #7 Chest pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chest-pain/symptoms-causes/syc-20370838

  Many different things can cause chest pain. The most life-threatening causes involve the heart or lungs. […] Chest pain has many possible causes. […] Some heart-related causes of chest pain are: Angina. This is any chest pain due to reduced blood flow to the heart muscle. It is often described as squeezing, pressure, heaviness, tightness or pain in the chest. Angina is a symptom of coronary artery disease. Unstable angina can cause a heart attack or near heart attack. […] A heart attack happens when blood flow to the heart muscle is blocked. It can cause angina chest pain. Emergency treatment is needed for a heart attack to prevent death. […] Aortic dissection. This life-threatening condition involves the body’s main artery, called the aorta. If the inner layers of the aorta separate, blood is forced between the layers. This can cause the aorta to rupture.

• #8 Causes of Chest Pain & Tightness

  https://www.webmd.com/pain-management/whats-causing-my-chest-pain

  Chest pain is not something to ignore. But you should know that it has many possible causes. In many cases, it’s related to the heart. But problems in your lungs, esophagus, muscles, ribs, or nerves may also cause chest pain. Some of these conditions are serious and life-threatening; others are not. If you have unexplained chest pain, the only way to confirm its cause is to have a doctor check you. […] Here are some of the more common causes of chest pain. […] These heart problems are common causes: […] Coronary artery disease (CAD). This blockage in the heart’s blood vessels lowers blood flow and oxygen to the heart muscle. It can cause pain, known as angina. […] Myocardial infarction (heart attack). This lowered blood flow through heart blood vessels causes the death of heart muscle cells.

• #9 Angina – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/angina/symptoms-causes/syc-20369373

  Angina is a type of chest pain caused by reduced blood flow to the heart. Angina is a symptom of coronary artery disease. […] Angina is caused by reduced blood flow to the heart muscle. Blood carries oxygen, which the heart muscle needs to survive. When the heart muscle isn’t getting enough oxygen, it causes a condition called ischemia. […] The most common cause of reduced blood flow to the heart muscle is coronary artery disease (CAD). The heart arteries, called the coronary arteries, can become narrowed by fatty deposits called plaques. This condition is called atherosclerosis. […] Plaque in a blood vessel may rupture or cause a blood clot. These events can quickly block or reduce flow through a narrowed artery. This can suddenly and severely decrease blood flow to the heart muscle.

• #10 Angina (Chest Pain) | American Heart Association

  https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain

  Angina is chest pain or discomfort due to your heart muscle not getting enough oxygen-rich blood. It can feel like pressure or squeezing in your chest. It may spread to your shoulders, arms, neck, jaw, abdomen or back. Sometimes, angina feels like an upset stomach. Some people don’t feel pain but have shortness of breath or fatigue. […] Angina is not a disease. It’s a symptom of a heart problem, usually coronary heart disease. There are different types of angina, including: Stable angina, Unstable angina, Microvascular Angina, Prinzmetal angina, Refractory angina. […] Angina usually happens because one or more of the coronary arteries is narrowed or blocked. This is called ischemia. […] Angina can also be a symptom of coronary microvascular disease. This heart disease affects the smallest arteries in the heart. It is more likely to affect women than men.

• #11 Chest pain: 27 causes, symptoms, and when to see a doctor

  https://www.medicalnewstoday.com/articles/321650

  Chest pain can stem from a heart problem, but other possible causes include a lung infection, muscle strain, a rib injury, or a panic attack. Some of these are serious conditions and need medical attention. […] Various heart problems can cause pain in the chest. […] Chest pain is one of the main symptoms of a heart attack. […] Myocarditis is inflammation of the heart muscle, resulting in symptoms that are similar to a heart attack, such as chest pain. […] Angina feels like a squeezing pain or pressure on the chest. […] Aortic dissection is a tear or separation of the inner layers of the aorta, the main artery that leads from the heart. […] Coronary artery dissection occurs when there is a tear in the coronary artery wall. […] Pericarditis is inflammation of the sac around the heart.

• #12 Chest pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chest-pain/symptoms-causes/syc-20370838

  Inflammation of the sac around the heart, called pericarditis. This condition usually causes sharp pain that gets worse when taking a breath or lying down. […] Chest pain can be caused by diseases or disorders of the digestive system, including: Gastroesophageal reflux disease (GERD). In this condition, stomach acid washes up from the stomach into the tube that connects the throat to the stomach. That tube is called the esophagus. GERD can cause a burning feeling in the chest, called heartburn. […] Many lung conditions can cause chest pain, including: A blood clot in the lung, called a pulmonary embolism. A blood clot that gets stuck in a lung artery can block blood flow to lung tissue. Symptoms of a pulmonary embolism may feel like a heart attack. […] Some types of chest pain are due to injury or damage to the structures that make up the chest wall. These conditions include: Costochondritis. This is inflammation of the cartilage that connects a rib to the breastbone. It can cause chest pain that might feel like a heart attack. The pain is most commonly felt on the left-hand side of the body.

• #13 Causes of Chest Pain & Tightness

  https://www.webmd.com/pain-management/whats-causing-my-chest-pain

  Myocarditis. Along with chest pain, this heart muscle inflammation may cause fever, fatigue, fast heartbeat, and trouble breathing. […] Pericarditis. This is an inflammation or infection of the sac around the heart. […] Hypertrophic cardiomyopathy. This genetic disease causes the heart muscle to grow abnormally thick. […] Mitral valve prolapse. It happens when a valve in the heart fails to close properly. […] Coronary artery dissection. Many things can cause this rare but deadly condition, which results when a tear develops in the coronary artery. […] Aortic dissection. It happens when there’s a tear in the inner layer of a weak spot in your aorta, the big artery carrying blood from your heart to the rest of your body. […] Aortic aneurysm. Aortic aneurysms are like bulging balloons that form in the aorta.

• #14 Chest pain: 27 causes, symptoms, and when to see a doctor

  https://www.medicalnewstoday.com/articles/321650

  Hypertrophic cardiomyopathy is the heart growing too thick due to genetic factors. […] Various lung problems can cause chest pain. […] Pulmonary hypertension is high blood pressure in the arteries that carry blood to the lungs. […] Pleurisy is inflammation of the membrane that covers the lungs. […] Lung infections such as pneumonia can cause sharp or stabbing chest pain. […] A pulmonary embolism is a blood clot getting trapped in an artery feeding blood to the lungs. […] Tuberculosis (TB) is a bacterial infection that usually affects the lungs and can cause chest pain. […] Asthma is a common breathing disorder characterized by inflammation in the airways, which can cause chest pain. […] Costochondritis is inflammation of the cartilage of the rib cage. It can cause pain and tenderness in the chest.

• #15 Causes of Chest Pain & Tightness

  https://www.webmd.com/pain-management/whats-causing-my-chest-pain

  Aortic stenosis. Your aortic valve is like a gatekeeper, allowing blood to move from the heart’s left lower chamber (left ventricle) into the aorta, carrying blood throughout your body. […] Heart rhythm problems. Also known as heart rhythm disorders, this can happen to anyone, even if you don’t have any other heart diseases. […] These are common causes of chest pain: […] Pleuritis. Also known as pleurisy, this is an inflammation or irritation of the lungs and chest lining. […] Pneumonia or lung abscess. These lung infections can cause pleuritic and other types of chest pain, such as a deep chest ache. […] Pulmonary embolism. When a blood clot travels through the bloodstream and lodges in the lungs, it can cause acute pleuritis, trouble breathing, and a rapid heartbeat. […] Pneumothorax. Often caused by a chest injury, pneumothorax happens when a part of the lung collapses, releasing air into the chest cavity.

• #16 Chest pain: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003079.htm

  A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body (aortic dissection) causes sudden, severe pain in the chest and upper back. […] Swelling (inflammation) in the sac that surrounds the heart (pericarditis) causes pain in the center part of the chest. […] Lung problems that can cause chest pain: A blood clot in the lung (pulmonary embolism). […] Collapse of the lung (pneumothorax). […] Pneumonia may cause a sharp chest pain that often gets worse when you take a deep breath or cough. […] Swelling of the lining around the lung (pleurisy) can cause chest pain that usually feels sharp, and often gets worse when you take a deep breath or cough. […] Other causes of chest pain: Panic attack, which often occurs with fast breathing.

• #17 Causes of Chest Pain & Tightness

  https://www.webmd.com/pain-management/whats-causing-my-chest-pain

  Pulmonary hypertension. With chest pain resembling that of angina, this abnormally high blood pressure in the lung arteries makes the right side of the heart work too hard. […] Asthma. An inflammatory disorder of the airways, asthma causes shortness of breath, wheezing, coughing, and sometimes chest pain. […] Chronic obstructive pulmonary disease (COPD). This includes one or more of three diseases emphysema, chronic bronchitis, and chronic obstructive asthma. […] Lung cancer. You get lung cancer when unusual cells grow out of control in your lungs. […] Gastrointestinal problems can also cause chest pain and include: […] Gastroesophageal reflux disease (GERD). Also known as acid reflux, GERD happens when stomach contents return to the throat. […] Esophageal contraction disorders. Uncoordinated muscle contractions (spasms) and high-pressure contractions (nutcracker esophagus) are problems in the esophagus that can cause chest pain.

• #18 Chest Pain: What It Feels Like, Causes & Treatment

  https://my.clevelandclinic.org/health/symptoms/21209-chest-pain

  Chest pain has many causes, like issues in your heart, lungs or digestive system. Some causes are life-threatening while others aren’t. […] Chest pain can come from heart, lung, digestive or other issues. GERD, or heartburn, is the most common cause. […] Gastroesophageal reflux disease (GERD or chronic heartburn) is the most common cause of chest pain. Heart issue or not, you should get medical attention to get a diagnosis and the treatment you need. […] Chest pain causes include: Heart attack (lack of blood to your heart). Coronary artery disease (CAD, a narrowing or blockage in your hearts arteries). Coronary artery dissection (tear in a heart artery). Pericarditis (inflamed sac around your heart). Hypertrophic cardiomyopathy (thick heart muscle). Aortic dissection (tear in your largest artery). Aortic aneurysm (weak area in your largest artery). Mitral valve prolapse (heart valve without a tight seal). Aortic stenosis (heart valve that blocks blood flow because it doesn’t open). Heart rhythm problems. Gastroesophageal reflux disease (GERD or chronic acid reflux). Ulcers (sores in your stomach lining). Muscle spasms in your esophagus (food tube). Esophagitis (inflamed food tube). Gallstones (hardened digestive fluid). Hiatal hernia (part of your stomach moving up toward your food tube). Gastritis (inflamed stomach lining). Pancreatitis (inflamed pancreas). Pulmonary embolism (PE, a blood clot in your lung). Chronic obstructive pulmonary disease (COPD or lung disease). Pneumonia (lung infection). Pleurisy or pleuritis (inflamed lining of your lungs). Pneumothorax (collapsed lung). Pulmonary hypertension (high blood pressure in your pulmonary arteries). Asthma (narrow airways). Rib fracture (broken rib). Sprained chest muscle. Costochondritis (swollen chest cartilage). Shingles (infection and rash). Lung cancer. Panic attack (sudden feeling of fear). […] Some causes of chest pain can be life-threatening. This includes some lung-related causes of chest pain, too. The safe bet is to see a healthcare provider who can diagnose and treat your chest pain.

• #19 Noncardiac Chest Pain: Symptoms, Causes and Treatments

  https://my.clevelandclinic.org/health/diseases/15851-gerd-non-cardiac-chest-pain

  Noncardiac chest pain is defined as recurring pain in your chest typically, behind your breast bone and near your heart thats not related to your heart. […] Noncardiac chest pain is most commonly related to a problem with your esophagus, the swallowing tube that connects your mouth to your stomach. There are several different esophageal disorders that can cause noncardiac chest pain, including: Gastroesophageal reflux disease (GERD). Otherwise known as chronic acid reflux, this is the most common cause of noncardiac chest pain, accounting for 50% to 60% of cases. […] Some less common causes of noncardiac chest pain include: Muscle or bone problems in the chest, chest wall or spine (back). Chronic lung diseases, including diseases of the pleura, the tissue that covers your lungs. Stomach problems, such as ulcers. Psychological problems, including pain disorders, stress, anxiety and depression. […] Correlation, but not causation, has been shown between noncardiac chest pain and: High BMI. Smoking or tobacco use. NSAIDs. Anxiety.

• #20 Causes of Chest Pain & Tightness

  https://www.webmd.com/pain-management/whats-causing-my-chest-pain

  Esophageal hypersensitivity. This occurs when the esophagus becomes very painful at the smallest change in pressure or exposure to acid. […] Esophageal rupture or perforation. A sudden, severe chest pain following vomiting or a procedure involving the esophagus may be a sign of a rupture in the esophagus. […] Peptic ulcers. These painful sores in the lining of the stomach or the first part of the small intestine may result in vague, repeated discomfort. […] Hiatal hernia. This common problem occurs when the top of the stomach pushes into the lower chest after eating. […] Pancreatitis. You may have pancreatitis if you have pain in the lower chest that is often worse when you lie flat and better when you lean forward. […] Gallbladder problems. After eating a fatty meal, do you feel full or have pain in your right lower chest area or the right upper side of your abdomen?

• #21 Causes of Chest Pain & Tightness

  https://www.webmd.com/pain-management/whats-causing-my-chest-pain

  Esophagitis. This happens when your esophagus, the tube that carries food from your mouth to your stomach, becomes inflamed. […] Sometimes, chest pain may result from overuse or an injury to the chest area from a fall or accident. […] Rib problems. Pain from a broken rib may worsen with deep breathing or coughing. […] Muscle strain. Sometimes, even hard coughing can injure or inflame the muscles and tendons between the ribs and cause chest pain. […] Shingles. Caused by the varicella-zoster virus, shingles may prompt a sharp, band-like pain before a telltale rash appears several days later. […] Costochondritis. Also called chest wall pain syndrome or costosternal chondrodynia, this is an inflammation of the cartilage connecting a rib to the breastbone. […] Another potential cause of chest pain is anxiety and panic attacks. […] Chest pain can signal various issues, from heart problems such as aortic dissection to lung conditions such as pneumonia.

• #22 Chest Pain: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/chest-pain

  The following are gastrointestinal causes of chest pain: acid reflux, or heartburn, especially after eating; swallowing problems related to disorders of the esophagus; gallstones, which can lead to upper abdominal pain or pain after eating; inflammation of the gallbladder or pancreas. […] The following are lung-related causes of chest pain: pneumonia, which causes pain that may get worse with breathing; viral bronchitis, which can cause soreness around your chest and muscle aches; pneumothorax (collapsed lung), causing a sudden onset of chest pain; a blood clot, or pulmonary embolus, which can cause sharp pain that worsens with breathing; bronchospasm, which causes chest tightness. […] The following are causes of chest pain related to the muscles or bones: bruised or broken ribs, which may be due to an injury to your chest; sore muscles from exertion or chronic pain syndromes; compression fractures causing pressure on a nerve.

• #23 Acute Chest Pain in Adults: Outpatient Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/1215/p721.html

  The combination of age, sex, and type of chest pain can predict the likelihood of coronary artery disease (CAD) as the cause of chest pain. […] Validated clinical decision rules can help determine whether chest pain is caused by CAD. […] Patients with localized musculoskeletal pain that is reproducible by palpation or pain reproducible by palpation of the parasternal costochondral joints likely have chest wall pain or costochondritis. […] Gastroesophageal reflux disease should be considered in patients with burning retrosternal pain, acid regurgitation, and a sour or bitter taste in the mouth. […] Panic disorder and anxiety states often cause chest pain and shortness of breath; physicians should consider using a single validated screening question to confirm the diagnosis. […] If the initial evaluation indicates that ACS is less likely or the diagnostic evaluation for ACS in higher-risk patients is negative, other non-ACS conditions that may cause symptoms similar to coronary ischemia should be considered.

• #24 Chest pain DDx • LITFL • CCC Differential Diagnosis

  https://litfl.com/chest-pain-ddx/

  The approach to non-traumatic chest pain requires the early recognition and exclusion of potential life threats, then further consideration of other causes. […] Potentially life-threatening causes of chest pain include cardiovascular issues such as acute coronary syndromes, aortic dissection, myocarditis, pericarditis, cardiac tamponade, pulmonary embolism, and cardiac valve disease. […] Common non-life-threatening causes of chest pain include gastrointestinal issues like biliary colic, gastroesophageal reflux, and peptic ulcer disease, as well as pulmonary issues such as pneumonia and pleurisy. […] Chest wall syndromes can also cause chest pain, including musculoskeletal pain, costochondritis, thoracic radiculopathy, and Tietze syndrome. […] Psychiatric causes of chest pain may include anxiety and somatisation, as well as Da Costa syndrome. […] Occult trauma, such as rib fractures, and infections like shingles can also be causes of chest pain.

• #25 What Are the Causes of Chest Pain and When Do I Need Help?

  https://www.healthline.com/health/causes-of-chest-pain

  If you’ve ever lifted something that was too heavy or you didn’t lift it correctly, you may have experienced a strained or bruised chest muscle. […] Fibromyalgia can cause a host of symptoms, including musculoskeletal pain that includes the chest. […] A broken or bruised rib can cause considerable chest pain every time you bend or twist your upper body. […] Costochondritis occurs when the cartilage that supports your ribs becomes inflamed.

• #26 Chest Pain or Discomfort – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK416/

  Symptoms accompanying chest pain often provide diagnostic clues. […] Various schemes have been used to classify the etiologies of chest pain, but the most useful is to distinguish between acute and chronic patterns of pain. […] The leading diagnostic consideration in patients with chronic chest pain is coronary artery disease. […] Esophageal disease is a common cause of recurrent chest pain. […] Myocardial ischemia sometimes occurs in the absence of fixed obstructions of the coronary arteries, resulting in recurrent chest pain. […] Coronary vasospasm can cause myocardial ischemia in the absence of obstructive coronary disease. […] Mitral valve prolapse is a controversial etiology of chronic chest pain. […] The chest wall can cause recurrent chest pain, but the clinical diagnosis of chest wall syndromes has not been described well.

• #27 Chest Pain: Causes, Approach and Evaluation – Manual of Medicine

  https://manualofmedicine.com/topics/chest-pain-causes-approach-evaluation/

  The differential diagnosis of chest wall tenderness includes the following: Rib fracture. Shingles (herpes zoster): pain precedes rash. Costochondritis (Tietzes syndrome). Nerve root compression. […] The differential diagnosis of chest pain as an atypical presentation (or in any of the above) includes: Anxiety and Panic Disorder Referred pain from vertebral collapse, causing nerve root irritation Intra-abdominal pathology (e.g., pancreatitis, peptic ulcer, or the biliary tree). […] For this reason, the most serious causes of chest pain should always be added to the differential diagnosis and considered to avoid missing a potentially life-threatening problem. […] Important risk factors include: Ischemic heart disease: smoking, family history, cholesterol, hypertension, diabetes, male sex, age over 50 years. PE: recent travel, immobility, or surgery, family history, pregnancy, malignancy. Pneumothorax: spontaneous (young, thin men), trauma, emphysema, asthma, malignancy, staphylococcal pneumonia, cystic fibrosis.

• #28 Chest pain: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003079.htm

  Inflammation where the ribs join the breast bone or sternum (costochondritis). […] Shingles, which causes sharp, tingling pain on one side that stretches from the chest to the back, and may cause a rash. […] Strain of the muscles and tendons between the ribs. […] Chest pain can also be due to the following digestive system problems: Spasms or narrowing of the esophagus (the tube that carries food from the mouth to the stomach) […] Gallstones cause pain that gets worse after a meal (most often a fatty meal). […] Heartburn or gastroesophageal reflux (GERD) […] Stomach ulcer or gastritis: Burning pain occurs if your stomach is empty and feels better when you eat food. […] In children, most chest pain is not caused by the heart.

• #29

  https://empendium.com/mcmtextbook/table/031_6880

  Extremely severe, tearing, of sudden onset […] High BP […] Murmur of mitral regurgitation, asymmetric BP in extremities, new-onset neurologic deficits […] Pleuritic pain […] Inflammatory infiltration of pleura, irritation of pleura in pulmonary infarction, pneumothorax […] Usually unilateral, may be referred to interscapular area […] Sharp, stabbing […] Exacerbated by deep inspiration, cough, trunk movement; reduced after lying down on the side of pain […] Features of underlying condition, usually dyspnea, tachypnea […] Neuralgia […] Neuritis (eg, in herpes zoster), nerve compression by spinal lesions […] Unilateral in herpes zoster, may be bilateral when caused by spinal lesions […] Sharp, shooting […] Exacerbated by palpation along nerve, sometimes with very light touch (allodynia)

• #29

  https://empendium.com/mcmtextbook/table/031_6880

  Table 1.28-1. The most frequent causes of chest pain and their differential diagnosis […] Cause […] Pathogenesis […] Location […] Features of pain […] Precipitating, exacerbating, and alleviating factors […] Selected accompanying signs or symptoms […] SIHD […] Transient myocardial ischemia […] Retrosternal, may be referred to neck, jaw, scapulae, arms, elbows, epigastrium […] Crushing, burning, squeezing; persists for 2-10 min […] Exercise, stress, cold air, heavy meals; resolves soon after stopping activity or use of nitroglycerin […] Dyspnea […] Acute coronary syndromes including NSTEACS and STEACS […] Prolonged myocardial ischemia, myocardial necrosis […] As above […] As above but usually more severe; persists for 30 min in MI, 20 min in angina pectoris […] Not resolving after use of nitroglycerin or stopping activity

• #30 Chest pain: 27 causes, symptoms, and when to see a doctor

  https://www.medicalnewstoday.com/articles/321650

  Inflammation of the muscles and tendons around the ribs can result in persistent chest pain. […] Injuries to the ribs, such as bruises, breaks, and fractures, can cause chest pain. […] Chest pain that comes on suddenly may be serious. […] Some common causes of chest pain, besides a heart attack, include myocarditis, angina, pneumonia, and Covid-19. […] Yes, it is possible for a person to have chest pain without a heart attack being the cause. […] An electrocardiogram (EKG) can offer important information, for instance, about possible narrowing of the coronary arteries, a heart attack, or an irregular heartbeat like atrial fibrillation.

• #31 What Are the Causes of Chest Pain and When Do I Need Help?

  https://www.healthline.com/health/causes-of-chest-pain

  Pneumonia isn’t a stand-alone disease, but a complication from the flu or other respiratory infection. […] Acid reflux is a common condition that results when stomach acid moves back up the esophagus and irritates the lining of the esophagus. […] Esophagitis is an inflammation of the tissue in the esophagus. […] The lining of the esophagus can sometimes tear. […] Dysphagia is the clinical term for a swallowing disorder. […] Gallstones are hardened little clusters of cholesterol or bilirubin. […] Pancreatitis is inflammation of the pancreas. […] There are several types of hernias, but the one that can cause chest pain is called a hiatal hernia. […] Anxiety can cause many physical symptoms, including chest pain. […] An anxiety attack is usually triggered by an upcoming event, such as a doctor appointment, speech, or other cause of nervousness.

• #32 Chest pain – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/chest-pain/symptoms-causes/syc-20370838

  Chest pain also can be caused by: Panic attack. If you feel intense fear with chest pain, you may be having a panic attack. Panic attack symptoms also include a fast, pounding heartbeat, fast breathing, a lot of sweating, shortness of breath, nausea and dizziness. It can be hard to tell the difference between a heart attack and a panic attack. Always get medical help if you aren’t sure of the cause of chest pain.

• #33 5 Causes of Chest Pain Unrelated to the Heart | The Harley Street

  https://www.harleystreet.sg/blog/5-causes-of-chest-pain-unrelated-to-heart/

  A pulmonary embolism occurs when one of the arteries in the lungs gets blocked. The clot blocks the blood returning to the lungs, which can lead to loss of life. Symptoms of pulmonary embolism include a short, sharp pain in the chest, shortness of breath, or fever. […] Sometimes, the tight pain you feel in your chest isn’t a result of heart conditions. It could be a result of either stress, panic attacks, or anxiety. […] Studies reveal that one out of four people experiences chest pains due to panic attacks. […] Non-cardiac chest pain (NCCP) refers to chest pain that is not caused by a heart problem and it is a very common condition that can be caused by a variety of factors. […] There are many causes of chest pain besides a heart attack. Some of the most common include gastroesophageal reflux disease (GERD), anxiety, muscle strain, costochondritis, pleurisy, pneumonia, hiatal hernia, and panic attacks among others.

• #34 Chest Pain or Discomfort – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK416/

  The leading diagnostic consideration in acute chest pain is myocardial infarction, a life-threatening condition requiring immediate medical management. […] The syndrome of unstable angina pectoris includes a diverse group of patients having chest pain due to coronary artery disease. […] Dissection of the thoracic aorta is a serious and potentially catastrophic cause of acute chest pain. […] Pericarditis is a moderately common disorder, and chest pain is a frequent symptom. […] Hyperventilation can cause pain that is atypical of angina pectoris.

• #35

  https://www.laparoscopyhospital.com/forum/forum.php?p=&cat_id=&tid=3635

  If you’re experiencing chest pain, it’s essential to seek medical attention promptly. Chest pain can be caused by a wide range of factors, including issues related to the heart, lungs, muscles, bones, or digestive system. […] Several lifestyle factors can contribute to chest pain. Here are some to consider: Diet: A diet high in unhealthy fats, cholesterol, sodium, and processed foods can contribute to heart disease, which may lead to chest pain. […] Lack of physical activity can increase the risk of heart disease and other health conditions that may cause chest pain. […] High levels of stress can trigger chest pain or exacerbate existing conditions such as heart disease or acid reflux. […] Smoking is a significant risk factor for heart disease and can worsen chest pain. […] Being overweight or obese can strain the heart and increase the risk of chest pain and heart disease.

• #36 Chest Pain: Locations, Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/chest_pain/article.htm

  Risk factors for pulmonary embolus include: Prolonged activities like a long trip in a car or airplane, Recent surgery or fracture, Birth control pills (especially associated with smoking), Cancer, Pregnancy. […] The narrowing of blood vessels or atherosclerosis is due to plaque buildup. […] If the plaque ruptures, it can cause a blood clot to form and completely block the vessel. […] When a coronary artery completely occludes (becomes blocked), the muscle it supplies blood to is at risk of dying. […] The most common cause of pericarditis either is a viral illness or is unknown (idiopathic). […] The majority of aortic dissections occur as a long-term consequence of poorly controlled high blood pressure. […] The pain from aortic dissection occurs suddenly and often is described as intense, stabbing, or ripping. […] The diagnosis of aortic dissection is confirmed by imaging, most commonly by CT angiography of the aorta.

• #37 Causes of Chest Pain

  https://www.clinicbarcelona.org/en/assistance/be-healthy/chest-pain/causes

  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. […] 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. […] 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. […] 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. […] In this case a pulmonary artery is obstructed by a clot that, generally, arises from the venous system of the legs.

• #38 Chest Pain or Discomfort – Clinical Methods – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK416/

  Pain, pressure, tightness, or other discomfort originating in or radiating to the chest constitutes an important indicator of potentially serious cardiac or cardiovascular disorders. […] Chest pain is one of the most common symptoms for which adults seek the care of a physician. […] A central goal is to determine whether the pain is likely caused by myocardial ischemia. […] Angina pectoris is a recognizable pain syndrome, and careful attention to the features of the history aids the clinician in determining whether a patient’s pain is typical of angina pectoris. […] The most important part of the chest pain history is to define what aggravates and relieves the pain. […] If the patient notes that less exertion is required to cause the pain when going out in cold weather or after eating a large meal, then the pain is likely to be caused by coronary artery disease.

• #39

  https://empendium.com/mcmtextbook/table/031_6880

  Dyspnea, excessive sweating, fatigue, nausea, vomiting […] Pericarditis/myopericarditis […] Irritation of pericardial layers or part of pleura adjacent to pericardium […] Retrosternal or over apex, may be referred to neck and left shoulder […] Sharp, stabbing, varying intensity […] Exacerbated by deep inspiration, trunk turning, supine position, cough; reduced when sitting and leaning forward […] Features of underlying condition, pericardial rub, dyspnea […] Hypertrophic cardiomyopathy […] Supply/demand mismatch due to decreased coronary flow, LVH, LVOTO […] As in SIHD […] As in SIHD […] Physical activity, dehydration, tachyarrhythmias, nitrates, and other preload- or afterload-reducing agents […] Dyspnea, presyncope or frank syncope, SCD […] Takotsubo cardiomyopathy

• #40

  https://empendium.com/mcmtextbook/table/031_6880

  Unknown but presumed due to catecholamine-induced cardiotoxicity […] Similar as in ACS […] Similar as in ACS […] Emotional or physical stress; strong female preponderance […] Dyspnea, heart failure, cardiogenic shock […] Valvular heart disease (AS/AI) […] Myocardial oxygen supply/demand mismatch […] Similar as in SIHD […] Similar as in SIHD […] Physical activity, resolves with rest […] Exertional dyspnea, exertional presyncope/syncope in AS, signs of heart failure […] PH […] Impaired coronary perfusion to a dilated and hypertrophied RV […] Similar as in SIHD […] Similar as in SIHD […] Similar to SIHD […] Dyspnea, fatigue, signs of right heart failure, signs and symptoms of underlying cause of PH […] Aortic dissection […] Distension of aortic wall […] Anterior chest wall, may be referred to interscapular or lumbar area

• #41

  https://empendium.com/mcmtextbook/table/031_6880

  Extremely severe, tearing, of sudden onset […] High BP […] Murmur of mitral regurgitation, asymmetric BP in extremities, new-onset neurologic deficits […] Pleuritic pain […] Inflammatory infiltration of pleura, irritation of pleura in pulmonary infarction, pneumothorax […] Usually unilateral, may be referred to interscapular area […] Sharp, stabbing […] Exacerbated by deep inspiration, cough, trunk movement; reduced after lying down on the side of pain […] Features of underlying condition, usually dyspnea, tachypnea […] Neuralgia […] Neuritis (eg, in herpes zoster), nerve compression by spinal lesions […] Unilateral in herpes zoster, may be bilateral when caused by spinal lesions […] Sharp, shooting […] Exacerbated by palpation along nerve, sometimes with very light touch (allodynia)

• #42 What causes chest pain| Ohio State Health & Discovery

  https://health.osu.edu/health/general-health/what-causes-chest-pain

  Aortic dissection occurs when the lining of the aorta suddenly rips or tears and is associated with acute, severe chest pain that often radiates to the back. […] Pneumothorax, or collapsed lung, is another life-threatening condition associated with acute chest pain and shortness of breath. Certain emergent gastrointestinal causes include tears in the esophagus or stomach. Depending on how severe, blunt trauma or injury to the chest wall can also be life-threatening.

• #43

  https://empendium.com/mcmtextbook/table/031_6880

  Rash typical of herpes zoster, tenderness of thoracic vertebrae […] GERD […] Esophagitis […] Retrosternal, may be referred to back […] Usually burning or squeezing […] Heavy meals, leaning forward, lying down […] Upper abdominal pain, dyspepsia […] Esophageal rupture […] Disruption of esophageal wall […] Retrosternal […] Very severe, burning, of sudden onset […] Forceful vomiting […] Vomiting […] Cholelithiasis […] Increased pressure in gallbladder […] Right hypochondrium or epigastrium, may be referred to right shoulder […] Severe pain with gradually increasing intensity, resolves slowly, persists for minutes to hours […] Fatty meals; alleviated by lying down still […] Nausea, vomiting, loss of appetite […] Peptic ulcer disease […] Gastric or duodenal mucosal injury

• #44

  https://empendium.com/mcmtextbook/table/031_6880

  Epigastrium, sometimes in lower chest […] Dull, rarely sharp or burning […] Exacerbated by meals (gastric ulcer) or fasting; meals alleviate symptoms in patients with duodenal ulcer […] Dyspepsia […] Bone and joint pain […] Inflammation of sternocostal and sternoclavicular joints, trauma, other […] Local, anterior chest wall […] Sharp or squeezing […] Chest wall movement, particularly cough […] Tenderness (often reproducible on palpation) […] Neurotic pain […] Unclear […] Anterior chest wall […] Variable […] Stress […] Dyspnea, palpitations, anxiety […] AI, aortic insufficiency; AS, aortic stenosis; BP, blood pressure; GERD, gastroesophageal reflux disease; LVH, left ventricular hypertrophy; LVOTO, left ventricular outflow tract obstruction; MI, myocardial infarction; NSTEACS, nonST-segment elevation acute coronary syndrome; PH, pulmonary hypertension; RV, right ventricle; SCD, sudden cardiac death; SIHD, stable ischemic heart disease; STEACS, ST-segment elevation acute coronary syndrome.

• #45 Chest Pain

  https://mobile.fpnotebook.com/CV/Sx/ChstPn.htm

  Chest Pain is the presenting complaint in 1% of ambulatory visits. […] Unstable Angina and Myocardial Infarction represent 4% of ambulatory Chest Pain presentations. […] Most common cause for clinic Chest Pain presentations are Chest Wall Pain, GERD and constochondritis. […] However, cardiac disease is the most common U.S. cause of death; have a high index of suspicion. […] Cardiac Risk Factors only weakly predict Acute Coronary Syndrome (especially with advancing age). […] Myocardial Infarction without Chest Pain occurs in up to 50% of patients. […] Women often present atypically (e.g. Dyspnea, weakness Nausea, Palpitations, Syncope) with Myocardial Infarctions. […] Greatest discrepancy between male and female ACS presentations are in the under age 45 cohort. […] Spontaneous Coronary Artery Dissection (SCAD) represents 40% of MI in women age under 50 years.

• #46 3 Common Causes of Chest Pain | Interventional Cardiovascular Specialists located in Dearborn, Detroit, Southfield, Wayne, and Allen Park, MI | Heart & Vascular Institute

  https://www.heartteam.com/blog/3-common-causes-of-chest-pain

  If youre experiencing chest pain, you should seek medical attention, but dont assume youre having a heart attack. This post describes three common causes of chest pain. […] There are multiple heart conditions and events that can cause chest pain. During a heart attack, or myocardial infarction, some people feel chest pain, but others dont. Chest pain isnt always a symptom of myocardial infarction. […] Aortic dissection is an emergency that causes sudden, severe pain in your chest, neck, throat, or jaw. You may feel like something inside is tearing. Aortic dissection is caused by uncontrolled high blood pressure, which may weaken the wall of your aorta. Eventually, that main artery tears. […] Angina is the medical name for chest pain thats caused by lack of sufficient blood flow to your heart. If you have angina, its likely worse with exertion. Its usually related to coronary artery disease, which is a buildup of plaque in your arteries. The plaque restricts the blood flow.

• #47 Chest pain – Wikipedia

  https://en.wikipedia.org/wiki/Chest_pain

  Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath. It can be divided into heart-related and non-heart-related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or the elderly may have less clear symptoms. […] Serious and relatively common causes include acute coronary syndrome such as a heart attack (31%), pulmonary embolism (2%), pneumothorax, pericarditis (4%), aortic dissection (1%) and esophageal rupture. Other common causes include gastroesophageal reflux disease (30%), muscle or skeletal pain (28%), pneumonia (2%), shingles (0.5%), pleuritis, traumatic and anxiety disorders. Determining the cause of chest pain is based on a person’s medical history, a physical exam and other medical tests. About 3% of heart attacks, however, are initially missed.

• #48 Chest pain – Wikipedia

  https://en.wikipedia.org/wiki/Chest_pain

  Management of chest pain is based on the underlying cause. Initial treatment often includes the medications aspirin and nitroglycerin. The response to treatment does not usually indicate whether the pain is heart-related. When the cause is unclear, the person may be referred for further evaluation. […] Causes of chest pain range from non-serious to life-threatening. In adults the most common causes of chest pain include: gastrointestinal (42%), coronary artery disease (31%), musculoskeletal (28%), pericarditis (4%) and pulmonary embolism (2%). Other less common causes include: pneumonia, lung cancer, and aortic aneurysms. Psychogenic causes of chest pain can include panic attacks; however, this is a diagnosis of exclusion. […] In children, the most common causes for chest pain are musculoskeletal (76-89%), exercise-induced asthma (4-12%), gastrointestinal illness (8%), and psychogenic causes (4%). Chest pain in children can also have congenital causes.

• #49 Chest Pain in Children | Causes & FAQs for Parents

  https://www.cincinnatichildrens.org/health/c/chest-pain

  Acid reflux can cause stomach or chest pain. […] Unlike adults, chest pain due to a cardiac cause is extremely uncommon in children. […] An inflammation of the heart lining, pericarditis is usually caused by a treatable infection, but can have other more serious causes. […] May limit the heart’s oxygen supply and cause symptoms similar to adults with cardiac chest pain. […] A minor abnormality of the valve that fills the main pumping chamber of the heart (the left ventricle). […] An arterial aneurysm is a stretching and out-pouching of the vessel that can lead to rupture. […] Other common causes include inappropriate accumulation of air, fluid or swelling in the chest as well as lung infections and asthma.

• #50 Chest Pain: Causes, Approach and Evaluation – Manual of Medicine

  https://manualofmedicine.com/topics/chest-pain-causes-approach-evaluation/

  ST depression and elevation on ECG are suggestive of myocardial ischemia and acute MI, respectively. […] Pneumothorax, consolidation (pneumonia, PE), widened mediastinum (aortic dissection), pulmonary edema (myocardial ischemia/infarction) and fractured ribs may be detected on CXR. […] Serial cardiac enzymes should be assessed every 8 hours for 24 hours if MI is considered. […] The presence of a dissecting aortic aneurysm should be confirmed by urgent echocardiography (particularly transesophageal echocardiography) or by computed tomography scan.

• #51 Chest Pain: Locations, Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/chest_pain/article.htm

  Deciding the cause of chest pain is sometimes very difficult and may require blood tests, X-rays, CT scans, and other tests. […] Chest pain is one of the most common symptoms that bring an individual to the emergency department. […] You may be worried that you are having a heart attack, but there are many other causes of pain in the chest that the doctor will consider. […] Some diagnoses of chest pain are life-threatening, while others are less dangerous. […] Pain can be caused by almost every structure in the chest. Different organs can produce different types of pain; unfortunately, the pain is not specific to each cause. […] Many reasons can cause chest pain, for example: Broken or bruised ribs, Pleuritis or pleurisy, Pneumothorax, Shingles, Pneumonia, Pulmonary embolus, Angina, Heart attack (myocardial infarction), Pericarditis, The aorta and aortic dissection, The esophagus and reflux esophagitis, Referred abdominal pain.

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