Chest pain: 17 possible causes (and what to do?)

La pain thoracic is one of the most common reasons for consultation in medical and surgical emergencies and in general practice. It is usually a source of anxiety, because the thorax contains two of the main vital organs of the human body, namely the heart and the lungs.

In addition, chest pain can be of abdominal origin. We then speak of irradiation or referred pain. Either way, determining the exact cause chest pain is essential. This is what will make it possible to measure its seriousness and to establish a specific treatment.

What is chest pain?

Chest pain, or chest pain, it is any pain or painful sensation located in the thorax (region located between the abdomen and the neck).

Like any pain, it has different characteristics:

• Location: chest pain can affect a specific area of ​​the chest. It can, for example, be basithoracic (at the base of the thorax), lateralized, precordial (near the heart), retrosternal (behind the sternum), etc.
• Extent : chest pain may be limited to a small area of ​​the chest, or be diffuse.
• Mode of occurrence: A distinction is mainly made between acute and chronic chest pain. We also talk about the mode of installation of the pain, it can be of sudden installation, or on the contrary progressive.
• Evolution in the time : chest pain can be continuous, that is to say permanent, or intermittent with periods of lull (alternating flare-remission).
• Type of pain: the words chosen by the patient to describe their chest pain are essential in guiding the diagnosis. We can then use words such as: burns, bites, tingling, pinching, oppression, stabbing, cramp...
• Intensity: light, moderate or intense. Generally, the patient is asked to rate the intensity of their chest pain on a scale of 1 to 10 (10 being synonymous with intolerable pain).
• Accompanying signs: chest pain may be accompanied by other symptoms that help guide the diagnosis (palpitations, difficulty breathing, cough, fever, vomiting, difficulty swallowing, rash, etc.).
• Triggering factors: factors that cause or aggravate chest pain such as exertion, exposure to intense stress, taking certain medications, etc.
• Sedative factors: factors that relieve or eliminate chest pain such as rest, lying down or leaning forward, taking painkillers…

Chest pain: 17 possible causes

La pain thoracic can be due to many causes. While some are benign, others may show a dangerous condition requiring treatment in extreme urgency. You should therefore never minimize chest pain and always ask your doctor.

Cardiovascular chest pain

We start with the different causes of chest pain of cardiovascular origin, because they are generally diagnostic and therapeutic emergencies. That is to say that it is imperative to recognize and treat them as early as possible.

1. Myocardial Infarction (MI)

Myocardial infarction (MI), commonly called " heart attack ", is a necrosis (death of cells) of a more or less extensive part of the heart muscle following an interruption of its vascularization by the obstruction of a coronary artery or one of its branches.

In other words, the blood no longer reaches the cells of certain parts of the heart, so no oxygen or nutrients, so cell death.

MI is an extreme emergency. It must be dealt with as soon as possible either by a revascularization by setting up a stent (kind of spring which serves to unclog the clogged artery), or by the administration of a drug which will destroy the clot blocking the artery (thrombolysis). The care is obviously different depending on the type of infarction, the proximity of an interventional cardiology center...

Be that as it may, once the infarctoid-like chest pain sets in, it's a real race against time that begins. Every minute counts! This is why it is necessary to know the characteristics of this pain, which are as follows:

• Headquarters : retrosternal (behind the sternum).
• Type: vice gripping the heart or chest. Sometimes with burns...
• Intensity: generally intense.
• Radiation: to the left upper limb (or both upper limbs), lower jaw, shoulders, back, stomach.
• Triggering factor : sometimes triggered by stress or emotional shock.

As soon as you experience this type of chest pain, or someone close to you describes it to you, go to a hospital immediately or call for help. A electrocardiogram will be quickly carried out in order to establish the diagnosis of myocardial infarction and the treatment immediately started.

2. Aortic dissection (AD)

Aortic dissection is a rare life-threatening condition. It corresponds to a aortic tear, the largest artery in the human body directly connected to the heart, which results in a separation of the layers of its wall. This tear can progress to a complete rupture leading, in the absence of care, to a mort some within seconds by massive internal bleeding.

It is therefore a urgency absolute ! It requires medical (blood pressure reduction) and surgical treatment without wasting a single second.

Chest pain during aortic dissection is usually very intense, migratory (i.e. it travels along the path of the aorta), which can secondarily be felt in the back and then in the lumbar region.

3. Pericarditis

Pericarditis is a inflammation of the pericardium, fibrous envelope surrounding the heart. It can be of viral origin (including COVID), bacterial, cancerous, tuberculous or metabolic. Sometimes it is complicated by pericardial effusion, that is to say the accumulation of fluid between the layers of the pericardium, thus hampering the functioning of the heart.

Chest pain caused by pericarditis is typically retrosternal, prolonged (several hours, days), radiates to the left trapezius, increased during respiratory movements and relieved by sitting or leaning forward.

4. Angina pectoris or “angina”

angina, or "angina" is a condition characterized by chest pain caused by decreased vascular supply, and therefore oxygenation, to the heart muscle. It is generally due to a decrease in the caliber of one or more arteries of the heart (coronary arteries and their branches) which is the origin (atherosclerotic plaque or fat in the arteries).

The typical pain of angina pectoris is retrosternal, constrictive, with feeling of having the heart squeezed in a vise, radiating to the left upper limb (or even both upper limbs) and the jaw, occurring on exertion (we then speaks of angina d'effort). She gives in after a few minutes of rest, thanks to the decrease in heart rate and contractility.

Be careful, angina pectoris can also manifest itself by pain epigastric (in the stomach region). This can sometimes confuse the issue and delay the diagnosis, especially when it is accompanied by heartburn or vomiting...

Chest pain of pulmonary origin

We continue with the pulmonary causes. Here too, we may be dealing with conditions for which treatment must be rapid and effective.

5. Pulmonary Embolism (PE)

Pulmonary embolism is a condition characterized by the sudden obstruction of the pulmonary artery, which connects the heart to the lungs, or one of its branches.

It manifests as pain basithoracic sudden onset, stabbed, accompanied by an increase in heart rate, shortness of breath and an increase in respiratory rate (dyspnea and polypnea).

His diagnosis must be made emergency. It is based on clinical arguments (description of pain, physical examination), on certain biological examinations (level of D-dimers) and possibly a CT angiography (which makes it possible to visualize the pulmonary vessels and highlight an obstruction).

6. Pneumothorax (PNO)

A pneumothorax (PNO) means the presence of air between the two layers of the pleura, a tough membrane entirely surrounding both lungs and lining the inner surface of the thoracic cavity.

A PNO can be spontaneous, preferentially affecting slender subjects (tall and thin), or provoked (secondary to a trauma or pathology of the lung).

The pain of pneumothorax is brutal, sharp, lateral and is often accompanied by respiratory discomfort, the intensity of which depends on the extent of the pneumothorax (the amount of air present between the layers of the pleura which compresses the lung).

Treatment must be urgent and depends on the extent of the pneumothorax. Sometimes a exsufflation, i.e. the drainage or evacuation of the air with the aid of a needle, is necessary to save the patient.

7. Pleurisy

Pleurisy means inflammation of the leaflets of the pleura (membrane composed of two adjoining sheets completely surrounding the lungs).

It can get complicated pleural effusion, that is to say the appearance of liquid between the two leaflets of the pleura.

It is manifested by acute chest pain, often unilateral (unilateral pleural effusion) intense and increased by deep inspiration or coughing.

Its diagnosis is based on the interrogation, the clinical examination of the respiratory system and the realization of a chest x-ray.

8. Pneumonia

Pneumonia refers to inflammation of the lungs following a bacterial or viral infection. The pain during this disease is usually unilateral (but can be bilateral), accentuated by coughing and sneezing, is accompanied by fever and shortness of breath.

Its evolution is most often towards healing, but some complications are to be feared. It is therefore important to consult quickly to benefit from adequate care. 

9. Lung tumor

A chest pain evolving for a long time and gradually installing, can be the witness of the presence of a lung tumor (benign or malignant).

You should know that chest pain is not systematic in cases of lung tumor. It may appear late, when it increases in size and infiltrates the pleura and neighboring structures. At this stage of development, there are general signs strongly suggestive of a neoplastic pathology such as fatigue intense and significant weight loss.

Chest pain of digestive origin

The rib cage contains part of the digestive tract: theesophagus. So, some conditions of this organ can cause chest pain.

In addition, there are so-called "abdominal pain referred to the chest". Indeed, certain damage to organs contained in the abdominal cavity (the stomach) can manifest as pain in the chest.

10. Hepatic colic

Hepatic colic is an attack of pain caused by the obstruction of a channel in the liver by small pebbles of variable composition called "gallstones" ou "gallstones".

Hepatic colic produces a stabbing pain that sits under the ribs on the right (right hypochondrium). It is typically brutal, persists for a few minutes to a few hours, often secondary to taking a fatty meal.

This pain, although of abdominal origin, radiates to the chest to reach the right shoulder. It can also radiate to the right lumbar region, and be confused with a lumbago.

A simple Abdominal ultrasound is usually enough to make the diagnosis of gallstones.

11. Acute cholecystitis

Acute cholecystitis is the inflammation of the lining of the vesicle biliary, whether or not associated with a bile infection. It is usually secondary to stones that obstruct the bile ducts of the liver.

The pain of acute cholecystitis is classically brutal, in the upper right part of the abdomen (right hypochondrium) or in its central part (epigastrium). She radiates to the right shoulder, realizing pain "in suspenders".

12. Peptic Ulcer (PUD)

A peptic ulcer (UGD) is a loss of substance in the gastric wall or duodenum (initial part of the small intestine, following the stomach). It is a kind of deep erosion.

The pain of UGD is classically of the type cramp occurring away from meals, realizing the famous "painful hunger". It is therefore calmed by food intake.

This pain can radiate to the chest and back.

13. Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is, as its name suggests, reflux or reflux of gastric (stomach) contents into the esophagus.

The lining of the esophagus is different from that of the stomach. It is not able to withstand acidity. GERD is therefore manifested by retrosternal burning pain. It is therefore capable of mimicking pain of cardiac origin (myocardial infarction).

Chest pain of parietal origin

Chest pain may be of parietal origin, i.e. due to damage to one of the constituents of the wall thoracic : the bones (ribs, clavicles, sternum, dorsal spine), muscles (intercostals, pectorals…), skin, cartilage, nerves…

It may be secondary to a trauma, or to a particular affection. To differentiate it from other chest pains, press on the affected area. If the pressure causes and reproduces the pain, we will conclude that there is parietal pain and we will look for its exact cause.

Here are some causes of chest pain of parietal origin:

14. Back osteoarthritis or “dorsarthrosis”

Dorsarthrosis is a gradual wear of intervertebral discs dorsal spine. It translates clinically into a chronic back pain which can radiate to any region of the thorax, joint stiffness, muscle tension, reduced mobility, etc.

Sometimes it can be totally painless, the dorsal part of the spine being little mobile devices compared to the cervical or lumbar region.

To learn more about dorsarthrosis, see the following article. 

15. Ankylosing Spondylitis (APS)

This is a disease rheumatic chronic characterized by inflammation of the joints of the spine and pelvis. It results in painful outbreaks interspersed with periods of calm.

Joint stiffness in the back and hip sets in gradually and can go as far as complete ankylosis, i.e. a total loss of joint mobility.

To know everything about the ankylosing spondylitis, see the following article.

16. Intercostal zona

It is a viral infection whose initial manifestation is prolonged chest pain called "in half-belt", that is, it starts from the back, goes to the side and stops at the midline. It therefore concerns only one side of the thorax, on a band region called "dermatoma".

Then appears a eruption cutaneous occupying the same painful territory, fever and deep fatigue.

17. Rib fracture

A fracture of one or more ribs can be secondary to a trauma of the thorax (fall, traffic accident, accident on the public highway, domestic accident, violent sport, etc.) or spontaneous (bone fragility: elderly, calcium or vitamin D deficiency, osteoporosis, etc.).

It can cause intense chest pain that is accentuated by deep inspiration. A chest X-ray is usually enough to make the diagnosis.

Psychological chest pain    

Sometimes chest pain has no detectable organic cause. Even after all possible examinations have been carried out. We then move towards a causes psychogenicwhich is a diagnostic elimination.

Indeed, a acute anxiety attack, a trough, intense emotional shock or other psychic factor can be manifested by all kinds of pain, chest pain in a relatively more frequent way.

Chest pain: What to do?

As you have seen through this article, the possible causes of chest pain are multiple. Some of them being serious, it is important to quickly go to the hospital or call 15 in order to eliminate in priority the diagnoses involving the vital prognosis.

Above all, do not hesitate to ask for help from health professionals, even if in the end there is no "absolutely nothing" wrong !

We give you, as an indication, some situations requiring consultation without delay:

• Sudden pain.
• Immediate intense pain.
• Pain radiating to lower, neck and/or jaws.
• Pain accentuated during inspiration.
• Pain that is accompanied by other symptoms: palpitations, shortness of breath, loss of consciousness, dizziness...

With your doctor, do not hesitate to provide as much detail as possible about the characteristics of your chest pain. Choose words that accurately describe what you feel, words such as burning, tingling, squeezing, tightness around the heart… Every detail counts and makes it easier to make a quick diagnosis.

Once the diagnosis is made, the treatment will be different from one disease to another:

• Myocardial infarction: revascularization by a stent, drugs to destroy the clot obstructing the artery (thrombolysis), surgical coronary bypass…
• Pulmonary embolism : anticoagulants, thrombolectomy…
• Aortic dissection : surgical treatment.
• Pneumonia: treatment according to the germ in question.
• Pneumothorax:
• Pleural fluid effusion: pleural drainage (puncture of fluid with a long needle).
• Muscle aches : muscle relaxant drugs, physiotherapy.
• Back pain: painkillers, physiotherapy, posture correction…
• Gallstones: cholecystectomy according to specific indications (removal of the diseased gallbladder).
• Peptic ulcer disease: medical treatment (antacids, anti-Helicobacter pylori antibiotics, etc.), surgery according to specific indications.
• Gastroesophageal reflux : lifestyle rules, antacid drugs, treatment of a possible hiatal hernia (sliding of part of the stomach into the thorax through the diaphragm)...

If the cause is mechanical

If you feel a chest pain that is not due to a heart problem, your doctor will likely diagnose a mechanical cause. This means that the pain is caused by something other than a disease and instead results from the way your body moves or the alignment of certain structures.

There are a number of effective treatments for this type of pain, and the best course of action will depend on the specific cause of your discomfort.

Here are five common treatments for mechanical chest pain:

• Physiotherapy : Un physiotherapist can help you improve your posture and teach you exercises that will strengthen your back and abdominal muscles, which can relieve pressure on your chest.

• Massage therapy: Massage can help loosen tight muscles and increase blood flow to the area, which can reduce inflammation and pain.

• Exercises: Specific exercises may be recommended to stretch and strengthen back and core muscles, which can help correct alignment issues and relieve pain.

• Acupuncture: This ancient Chinese healing technique involves inserting fine needles into the skin at specific locations, which can help release tension and promote healing.

• Chiropractic care: A chiropractor can use manual adjustments to improve alignment and relieve pressure on the chest.

If the cause is psychological and not mechanical

If your doctor rules out a physical cause for your chest pain, it is likely that the cause is psychological. There are a number of effective treatments for psychological chest pain, and the best course of action will depend on the underlying cause of your discomfort.

Here are four common treatments for non-mechanical chest pain:

• Cognitive-behavioral therapy: This type of therapy can help you identify and change negative thought patterns that may be contributing to your pain.

• Relaxation Techniques: Relaxation techniques, such as deep breathing or progressive muscle relaxation, can help reduce stress and relieve symptoms of illness.

• Medicines: In some cases, medication may be needed to control symptoms. Antidepressants and anti-anxiety and pain medications are commonly prescribed for non-mechanical chest pain.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat chest pain, especially for their anti-inflammatory properties. It is essential to consult your doctor beforehand, mainly to avoid drug interactions and side effects.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation. The products are available on the site Country. Use promo code LOMBAFIT15 if you wish to obtain one of the following products, or any remedy aimed at relieving your symptoms and improving your quality of life:

• Turmeric. Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
• Ginger. In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. the gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
• Omega-3s. Omega-3s are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Sciatica, being most often linked to an inflammation secondary to a herniated disc, it can also respond to omega-3 provided it is consumed regularly. 
• Lemon eucalyptus. Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
• wintergreen. Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

Remember that these products should never replace medical treatment. Consult a healthcare professional for treatment adapted to your condition.

Resources

References

[1] H. Rousseau, F.-M. Lopez, and B. Padovani, “Chest Pain,” J. Radiol., flight. 85, n^o 9, p. 1396, 2004.

[2] R. Poirson and A. Szymanowicz, "Assessment of professional practices (EPP): management (PEC) of acute chest pain in the emergency room", Immuno-Anal. Biol. spec., flight. 25, n^o 4, p. 197-204, 2010.

[3] F. Lapostolle, M. Ruscev, S. Darricau, T. Petrovic, C. Lapandry, and F. Adnet, “Emergency diagnostic strategy for a patient with chest pain”, Prat. In Anesth. Intensive care, flight. 14, n^o 2, p. 101-105, 2010.

[4] P. Ray and B. Riou, “Diagnostic approach to chest pain”, Therapeutic Medicine, flight. 6, n^o 6, p. 466-73, 2000.

[5] “Chest pain in ambulatory medicine. Without forgetting the patients who have "nothing at heart", Swiss Medical Review. https://www.revmed.ch/revue-medicale-suisse/2007/revue-medicale-suisse-135/thoracic-pains-in-ambulatory-medicine.-without-forgetting-les-patients-qui-n-ont -nothing-to-the-heart (accessed February 12, 2022).