Medical causes of pain in chest region.

1. C H E S T P A I N

2. Introduction
Chest pain appears in many forms, ranging
from a sharp stab to a dull ache. Sometimes
chest pain feels crushing or burning. In
certain cases, the pain travels up the neck,
into the jaw, and then radiates to the back or
down one or both arms.
Many different problems can cause chest
pain. The most life-threatening causes
involve the heart or lungs. Because chest
pain can indicate a serious problem, it's
important to seek immediate medical help.

3. Locations of chest pain

4. Locations of chest pain

5. Heaviness, pressure,
fullness, squeezing,
burning or tightness
in chest.
Crushing pain that
may radiate to back,
neck, jaw, shoulders,
and one or both
arms.
Pain may last
more than a
few minutes
or more, gets
worse with
activity, goes
away and
comes back,
or varies in
intensity.
Shortness of
breath & the pain
intensifies when
the patient
breathe deeply or
cough.
Tenderness when
pushing on chest.
Symptoms of chest pain (In General):

6. Causes of ACUTE chest pain
Angina pectoris
1
Coronary thrombosis leading to myocardial infarction
2
Massive pulmonary embolism & pulmonary infarction
3
Spontaneous pneumothorax & acute massive collapse
4
Acute pleurisy & acute pericarditis
5
Dissecting aortic aneurysm
6
Esophageal spasm, Perforating peptic ulcer, Cholecystitis
7
Cardiac neurosis
8

7. Psychogenic Pathological
Causes of chest pain
Cardiac Neurosis Cardiac
Non-Cardiac
1
2

8. Cardiovascular symptoms in
anxiety neurotic patient.
Pain is inflammatory at the
apex of the heart, stitching
or pricking, of long
duration.
Cardiac Neurosis (psychogenic pain)
Pain occurs commonly after
(not during) exercise and not
relieved by rest.
Other symptoms include
palpitation, fatigue,
breathlessness, headache
and emotional upsets.

9. Psychogenic Pathological
Causes of chest pain
Cardiac Neurosis Cardiac
Non-Cardiac
1
2

10. Restriction in blood
supply to Cardiac tissues,
causing a shortage of
oxygen that is needed for
cellular metabolism (to
keep tissue alive).
Ischemic
Cardiac Causes of Chest Pain
Coronary Causes
A B  COP LV Hypertrophy
Non-Coronary
Resulting
in:
Angina pectoris (transient): stable & unstable
1
Myocardial infarction (continuous).
2
Non-Ischemic
Pericarditis: Central chest pain, aggravated by movement, posture,
respiration and coughing.
A
Aortic aneurism
C
Dissecting aortic aneurism: Sudden central chest pain radiating to the
back.
B
Pulmonary embolism
D

11. Cardiac Causes of Chest Pain
Coronary Artery Disease (Ischemic) Aortic aneurism (Non-Ischemic)

12. Cardiac Causes of Chest Pain
Left Ventricular Hypertrophy (Ischemic) Dissecting Aortic aneurism (Non-Ischemic)

13. Psychogenic Pathological
Causes of chest pain
Cardiac Neurosis Cardiac
Non-Cardiac
1
2

14. Chest Wall
Non-Cardiac Causes of Chest Pain
Ribs and spine associated with local tenderness.
Fractures: traumatic & pathologic
Inflammations:
Neoplasms:
osteomyelitis & Pott's disease.
mostly malignant (e.g.,
secondaries.)
Diseases of the muscles: Myalgia & myositis, specially of rheumatic
origin (pain & tenderness in the
intercostal spaces & on pinching or
moving the muscles).

15. Chest Wall
Nervous causes
Local: neuritis & neuralgia.
Central: tabetic crisis, Herpes zoster
Breast Inflammations
Non-Cardiac Causes of Chest Pain

16. Pleurisy
Spontaneous pneumothorax
Pulmonary embolism & infarction
Pleuro-pulmonary
Broncho-pulmonary conditions reaching the
parietal pleura (e.g., Bronchial carcinoma).
Tracheitis: sense of retrosternal soreness
N.B. The lung & visceral pleura don't contain pain nerve ends.
Non-Cardiac Causes of Chest Pain

17. Mediastinitis
Space occupying lesions in the mediastinum
(e.g., mediastinal tumors)
Esophageal causes: e.g., infiltrating malignancy.
Mediastinal conditions
Non-Cardiac Causes of Chest Pain
Diaphragmatic conditions:
Diaphragmatic pleurisy
Diaphragmatic hernia especially when strangulated
Abnormal conditions Gall bladder disease &
Subdiaphragmatic abscess.

18. Causes of Shoulder Pain:
1 Local:
• Myositis.
• Shoulder dislocation.
• Abscess.
2 Referred:
Through phrenic nerve:
A
Subphrenic abscess: pain is referred to the shoulder at
the same side of the abscess.
N.B. Acute cholecystitis: pain is referred to the Rt. shoulder.
Cervical spondylosis
B Ischemic heart disease
C
3 Functional (Psychogenic).

19. Site of pain
How to comment on Chest Pain (In Sheet)?
As any Pain;
Radiation of pain or referred pain
Character of pain
What precipitates pain
What relieves pain
Duration of pain
Associated symptoms
1
2
3
4
5
6
7
Now we will comment on Angina and Myocardial Infarction Pain for example.

20. Anginal Pain
1 Site and radiation:
retrosternal and radiates to Lt. shoulder, inner
side of the arm, elbow and Lt. little finger or
Jaw.
2 Character:
Constricting, oppression, squeezing or pressure on the chest (the
patient doesn't point to it by one finger but by a fist).
N.B. It is never stitching never inframammary.
3 Duration:
Minutes (not seconds or hours) usually 2-10 min.
If >30 min, suggest myocardial infarction.

21. 4 Factors precipitating pain:
Any factor causing tachycardia (e.g., exertion, emotion, or exposure to cold).
5 Factors relieving pain:
Rest or nitroglycerin.
6 Associated symptoms:
Sever pain may provoke sweating, dizziness and fear.
Anginal Pain

22. Myocardial Infarction
1 Like Angina but:
• More severe, it may be severe enough to be described as
the worst pain the patient has ever felt.
• Radiates more: may below epigastric area but never below
umbilicus
• Unrelated to precipitating factors; may at rest.
• Not relieved by rest or sublingual nitrate.
• Associations: may be associated with complications.
2 Duration:
If >30 min, then it is myocardial infarction.