CHEST PAIN
In adults, chest pain is often caused by cardiac conditions, whereas in children and adolescents, the cause is most frequently non-cardiac.
Chest pain consistent with coronary artery obstruction is typically described as retrosternal, located behind the sternum, and expressed by patients as discomfort, heaviness, tightness, pressure, or constriction. The pain usually increases gradually over the course of several minutes. Physical exertion or emotional stress are common triggers. Anginal symptoms that occur at rest or with minimal exertion are usually seen in patients with acute coronary syndrome (i.e., heart attack).
Other common symptoms related to impaired cardiac perfusion include shortness of breath, palpitations, sweating, dizziness, presyncope, syncope, upper abdominal pain, gastric discomfort unrelated to meals, nausea, and vomiting.
However, it should be remembered that in patients with diabetes, women, older adults, and postoperative patients, ischemic heart disease may present atypically—such as sharp pain described as a stabbing sensation in the left or right side of the chest, or discomfort in the throat or abdomen.
Sharp chest pain that worsens with inspiration or when lying flat is not typically associated with ischemic heart disease. Such symptoms are more commonly seen in cases of acute pericarditis (inflammation of the pericardial membrane).
Very brief episodes of chest pain lasting only a few seconds are unlikely to be caused by ischemic heart disease. Pain that is highly localized, or radiating to areas like the navel or below the hips, is also not characteristic of impaired cardiac perfusion. Positional chest pain is generally non-ischemic. Musculoskeletal problems frequently cause chest pain as well—these often develop after exercise or lifting heavy objects and may worsen with certain positions, physical activity, or deep breathing. If chest pain is unilateral, worsens with palpation, and is accompanied by difficulty breathing, costochondritis (rib inflammation) should be considered.
Gastrointestinal conditions such as reflux, gastritis, and dietary issues can also cause chest pain. Respiratory system disorders—including pneumonia, pleurisy, and asthma attacks—may similarly result in chest discomfort.
In young individuals, approximately 10–20% of chest pain cases are psychogenic. Associated symptoms may include headache and abdominal pain. Hyperventilation syndrome, panic attacks, and depression may also lead to psychogenic chest pain. These patients typically have a completely normal physical examination.
In hypertensive patients, those with bicuspid aortic valve, or individuals with aortic dilation, the presence of sudden, tearing chest pain—often described as the most severe pain of their life—should raise immediate concern for aortic dissection or other acute aortic syndromes.
If you experience chest pain, you should consult a physician; if the pain is severe or medical care cannot be accessed promptly, you should visit the nearest emergency department.
