Chest pain – causes

Differentiate on history but beware of apparent “atypical” chest pain:

• Unstable angina pectoris / acute myocardial infarction (STEMI, NSTEMI)
• pericarditis
• dissecting / enlarging aortic aneurysm
• pulmonary embolus
• lung infection
  • pleurisy
  • pneumonia
• musculoskeletal disease
  
  • costochondritis
• oesophageal disease – sensitising effect
  • oesophageal spasm (“nutcracker oesophagus”) 
  • GORD 
• mediastinitis
• pancreatitis ?

Once cardiac, pulmonary, and muscular  conditions have been excluded, the vast majority of patients are found to have an esophageal source for their chest pain. Although often related to meals, oesophageal chest pain can also be precipitated by emotion and exercise—qualities that mimic the symptoms of angina pectoris attributable to ischaemic heart disease (IHD) … and medical treatments of angina [CCBs and nitrates] often have beneficial effects on oesophageal symptoms.¹

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Works cited

1. Heatley M, Rose K, Weston C. “The heart and the oesophagus: intimate relations.” Postgraduate Medical Journal 2005;81:515-518.

Hickam DH. “Chest Pain or Discomfort.” In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 9. Available from: https://www.ncbi.nlm.nih.gov/books/NBK416/. 

Spalding L, Reay E, Kelly C. “Cause and outcome of atypical chest pain in patients admitted to hospital.” J R Soc Med. 2003 Mar;96(3):122-5. doi: 10.1258/jrsm.96.3.122. PMID: 12612112; PMCID: PMC539418.

Winzenberg, Tania; Jones, Graeme; Callisaya, Michele. “Musculoskeletal chest wall pain.” AFP 44(8), August 2015: 540-544.