What Is Causing My Chest Pain

Five Keck Medicine specialists share common causes and treatment options.

Never ignore chest pain. While it’s not always heart-related, experts emphasize it’s critically important to rule out life-threatening cardiac reasons first.

Cardiovascular

According to interventional cardiologist Ray Matthews, MD, see a cardiologist if you have a family history of heart disease or have conditions such as diabetes or elevated cholesterol.

Chest tightness with exercise is also a red flag. Sudden, squeezing chest pain that “feels like the worst pain of your life and doesn’t go away within a few minutes” warrants a 911 call.

Emergencies:

• Aortic dissection
• Heart attack

Chronic conditions requiring cardiologic management:

• Atrial fibrillation
• Coronary artery disease
• Heart valve diseases like aortic stenosis

Treatment options:

• Medications to lower blood pressure and cholesterol
• Supervised exercise and dietary changes
• Stenting procedures
• Minimally invasive or open-heart surgery

Gastrointestinal

“Reflux is probably the most common cause of non-cardiac chest pain, when acid and bile injure the esophagus,” says gastrointestinal surgeon John Lipham, MD.

If medications don’t ease the chest pain, specialists can perform swallowing tests, an upper endoscopy or a high-resolution manometry test to diagnose esophageal issues such as:

• Gastroesophageal reflux
• Esophageal motility disorders: When muscles and nerves in the esophagus cause difficulty swallowing
• Esophageal strictures: Abnormal narrowing of the food pipe

Treatments:

• Diet adjustments
• Acid-reducing or muscle-relaxing medications
• Endoscopic procedures

Thoracic/Pulmonary

Problems with the lungs or issues affecting the muscles, bones and nerves within the chest cavity can cause discomfort ranging from tender to sharp.

“New onset pain with shortness of breath or a fainting episode needs prompt evaluation in an emergency department,” says thoracic surgeon Graeme Rosenberg, MD.

Potential causes:

• Costochondritis: Inflammation of cartilage connecting the ribs to the sternum
• Pneumothorax: A collapsed lung
• Pulmonary embolism: Blood clot in the lungs
• Rib fractures
• Severe pneumonia
• Lung inflammation

Treatment depends on cause but may include:

• Supplemental oxygen
• Nonsteroidal anti-inflammatory medications
• Placement of a chest tube
• Blood-thinning medications
• Surgery

Musculoskeletal

Chest pain that occurs when touching a certain area or when making specific movements can indicate a musculoskeletal problem.

Sports medicine physician Cara Hall, MD, says she often sees overuse injuries in athletes whose sports involve repetitive motion, like rowing or golf.

“Illnesses with a lot of coughing can also cause stress to the ribs or the muscles in between,” says Dr. Hall, adding that the three most common causes of chest pain she treats are:

• Costochondritis
• Intercostal muscle strain
• Rib stress reaction

Treatments:

• Icing
• Anti-inflammatory medication
• Rest
• Physical therapy

Psychological

Psychiatrist Steven Siegel, MD, PhD, explains that if chest pain only occurs during specific stressful situations, and other physical reasons have been ruled out, then the underlying cause could be psychological.

“Then we can address what makes it go away, like redirecting your attention or learning how to put things in a context,” he says.

Potential causes:

• Panic disorders
• Anxiety
• Depression
• Hypervigilance

Treatments:

• Cognitive behavioral therapy
• Breathing techniques
• Antidepressants

Topics

Erin Laviola

Erin Laviola is a freelance writer for Keck Medicine of USC.

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