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Chest pain may be due to many different causes, hence it is very important to have an accurate description of the pain to assist diagnosis.
As some of the causes are potentially life-threatening, and must always be considered first, a brief list of important questions is given here.
Diagnosis
The initial diagnosis is based on the following questions:
• How long does it last?
A sharp pain lasting only a few seconds may be due to chest wall muscle problems. Pain that persists for many minutes must always be considered as important.
• Does the pain spread to other parts of the body?
The pain of angina often spreads to the jaw, shoulder or arm. However, pain may start elsewhere, such as in the upper abdomen, and could later be felt in the chest. This may also happen with pancreatic, gall-bladder or stomach problems.
• Are there other associated symptoms?
A combination of chest pain with shortness of breath, dizziness, nausea, changes in blood pressure, change in pulse rate/rhythm, and sweating is highly suggestive of a heart attack or a pulmonary embolism.
• Are there any injuries?
Accidents may cause injuries to the chest wall, and even a dissection or rupture of the oesophagus or aorta. This will need emergency attention.
• What makes the pain better or worse?
Eating can worsen the pain caused by ulcers or gall-bladder problems. Deep breathing, coughing or sneezing will worsen the pain of lung-related problems such as pleurisy or pneumothorax. If direct pressure on an area of the chest wall elicits pain, it is probably due to muscle or rib problems.
Special investigations
These are important, due to the overlap of symptoms caused by different conditions. Once the clinical diagnosis indicates which organ is likely to be the cause, the appropriate investigations are done.
The most important investigations done initially are ECG and chest X-ray: these will indicate whether there is a:
• Heart condition, such as heart attack, coronary artery disease or pericarditis
• Lung condition, such as pneumothorax
• Aortic dissection
• Rib fracture
If these first investigations rule out the important conditions needing emergency attention, then other tests, such as blood tests, gastroscopy and abdominal ultrasound, are done. These tests may detect problems related to peptic ulcer disease, gall bladder or oesophagus.
Other special investigations may include computerised scans, or surgery to obtain tissue samples for examination.
As some of the causes are potentially life-threatening, and must always be considered first, a brief list of important questions is given here.
Diagnosis
The initial diagnosis is based on the following questions:
• How long does it last?
A sharp pain lasting only a few seconds may be due to chest wall muscle problems. Pain that persists for many minutes must always be considered as important.
• Does the pain spread to other parts of the body?
The pain of angina often spreads to the jaw, shoulder or arm. However, pain may start elsewhere, such as in the upper abdomen, and could later be felt in the chest. This may also happen with pancreatic, gall-bladder or stomach problems.
• Are there other associated symptoms?
A combination of chest pain with shortness of breath, dizziness, nausea, changes in blood pressure, change in pulse rate/rhythm, and sweating is highly suggestive of a heart attack or a pulmonary embolism.
• Are there any injuries?
Accidents may cause injuries to the chest wall, and even a dissection or rupture of the oesophagus or aorta. This will need emergency attention.
• What makes the pain better or worse?
Eating can worsen the pain caused by ulcers or gall-bladder problems. Deep breathing, coughing or sneezing will worsen the pain of lung-related problems such as pleurisy or pneumothorax. If direct pressure on an area of the chest wall elicits pain, it is probably due to muscle or rib problems.
Special investigations
These are important, due to the overlap of symptoms caused by different conditions. Once the clinical diagnosis indicates which organ is likely to be the cause, the appropriate investigations are done.
The most important investigations done initially are ECG and chest X-ray: these will indicate whether there is a:
• Heart condition, such as heart attack, coronary artery disease or pericarditis
• Lung condition, such as pneumothorax
• Aortic dissection
• Rib fracture
If these first investigations rule out the important conditions needing emergency attention, then other tests, such as blood tests, gastroscopy and abdominal ultrasound, are done. These tests may detect problems related to peptic ulcer disease, gall bladder or oesophagus.
Other special investigations may include computerised scans, or surgery to obtain tissue samples for examination.
