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CHEST PAIN
Causes
Chest pain has many possible causes, all
of which deserve medical attention. The causes of chest pain fall into two
major categories — cardiac and noncardiac causes.
Cardiac causes
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Heart attack.
A heart attack — a blood clot that's blocking blood flow to your heart
muscle — can cause pressure, fullness, or a squeezing or crushing pain
in your chest that lasts more than a few minutes. The pain may radiate
to your back, neck, jaw, shoulders and arms, especially your left arm.
Other signs and symptoms may include shortness of breath, sweating,
dizziness and nausea. All, some or none of these may accompany your
chest pain.
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Angina.
Fatty deposits can build up in the arteries that carry blood to your
heart, narrowing them and temporarily restricting blood flow to your
heart, especially during times of exertion. Restricted blood flow to
your heart can cause recurrent episodes of chest pain — angina
pectoris, or angina. Angina (an-JI-nuh or AN-juh-nuh) is often described
as a pressure or tightness in the chest. It's usually brought on by
physical or emotional stress. The pain usually goes away within minutes
after you stop the stressful activity.
Other problems that can cause chest pain include inflammation of the sac
surrounding your heart (pericarditis), a short-lived condition often
related to a viral infection. Pericarditis causes sharp, piercing and
centralized chest pain. You may also have a fever and feel sick. A rare,
life-threatening cause of chest pain called aortic dissection 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, also known as
Prinzmetal's angina, Syndrome X or endothelial dysfunction, also can
cause varying degrees of chest discomfort. In coronary spasm, coronary
arteries — arteries that supply blood to the heart — go into spasm,
temporarily limiting blood flow to the heart. Spasms of the coronary
arteries may occur spontaneously or be triggered by a stimulant, such as
nicotine or caffeine. Coronary artery spasms, which tend to cause
episodes of chest pain, can occur with activity or at rest. The spasms
may even wake you from sleep. The condition may coexist with coronary
artery disease — the buildup of fatty deposits in the coronary
arteries.
Noncardiac
causes
Many conditions unrelated to your heart
can cause chest pain. These include:
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Heartburn.
Stomach acid that washes up from your stomach into the tube that runs
from your mouth to your stomach (esophagus) can cause heartburn — a
painful, burning sensation behind your breastbone (sternum). Often this
feeling is accompanied by a sour taste and the sensation of food
re-entering your mouth (regurgitation). Heartburn-related chest pain
usually follows a meal and may last for hours. Signs and symptoms occur
more frequently when you bend forward at the waist or lie down.
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Panic attack.
If you experience discrete 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.
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Pleurisy.
Sharp, localized chest pain that's made worse when you inhale or cough
may point to pleurisy as a cause. This condition 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 attacks healthy tissue.
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Costochondritis.
In this condition — also known as Tietze's syndrome — the cartilage
of your rib cage, particularly the cartilage that joins your ribs to
your breastbone, becomes inflamed. The pain from costochondritis (kos-toe-KHON-dri-tis)
may occur suddenly and be intense, leading you to assume you're having a
heart attack. Yet the location of the pain is different. Costochondritis
causes your chest to hurt when you push on your sternum or on the ribs
near your sternum. Heart attack pain is usually more widespread, and the
chest wall usually isn't tender.
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Pulmonary embolism.
This condition occurs when a blood clot becomes lodged in a lung artery,
blocking blood flow to lung tissue. Symptoms of this life-threatening
condition can include sudden, sharp chest pain that begins or worsens
with a deep breath or cough. Other signs and symptoms can include
shortness of breath, rapid heartbeat, anxiety and faintness. It's rare
for pulmonary embolism to occur without preceding risk factors, such as
recent surgery or immobilization.
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Other lung conditions.
A collapsed lung (pneumothorax), high blood pressure in the arteries
carrying blood to the lungs (pulmonary hypertension) and severe asthma
can also produce chest pain.
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Sore muscles.
Muscle-related chest pain tends to come on when you twist side to side
or when you raise your arms. Chronic pain syndromes, such as
fibromyalgia, can produce persistent muscle-related chest pain.
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Injured ribs or pinched nerves.
A bruised or broken rib, as well as a pinched nerve, can cause chest
pain that tends to be localized and sharp.
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Swallowing disorders.
Several disorders of the esophagus, the tube that runs from your mouth
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. Because esophageal spasms can be
calmed with the medication nitroglycerine — which also rapidly
relieves some heart-related pain — this condition is sometimes
mistaken for a heart problem. Another swallowing disorder, which also
affects a small group of people with chest pain, is achalasia (ak-uh-LA-zhuh).
In this condition, 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. Pain with swallowing also can accompany
heartburn.
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Shingles.
This infection of nerves caused by the chickenpox virus can produce pain
and a band of blisters on your back around to your chest wall. This
sharp, burning pain may begin several hours to a day or so before
blisters appear.
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Gallbladder or pancreas problems.
Gallstones or inflammation of your gallbladder (cholecystitis) or
pancreas can cause acute abdominal pain that radiates to your chest.
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Cancer.
Rarely, cancer involving the chest or cancer that has spread from
another part of the body can cause chest pain.
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