Vascular cause of chest pain

Hypertension. High BP is the most common cause of chest pain. When BP is elevated, the small coronary arteries within the heart collapse as the ventricle tries to pump blood against high pressure. The pain may dissipate as BP returns to normal.

GI causes of chest pain

Heartburn. As stomach acid refluxes back into the esophagus, a patient may complain of a burning sensation behind the sternum.


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Hiatal hernia. Caused by part of the stomach ascending above the diaphragm, this condition can cause chest pain or pressure. It is especially noticeable after eating.

Peptic ulcer perforation. Also known as a perforated ulcer, this emergency may present as lower chest pain, tachycardia, hypotension, and changes in the electrocardiogram.

Cholecystitis. Inflammation of the gallbladder results in right-upper-quadrant abdominal pain that may radiate to the right side of the chest. Typically, this condition follows a high-fat meal and may be accompanied by nausea and vomiting.

Acute pancreatitis. In this condition, severe pain is described in the left upper quadrant and may radiate into the left chest. Lying supine worsens discomfort. Pain may also be accompanied by nausea, vomiting, and fever.

Lifestyle causes of chest pain

Alcohol. Excessive alcohol consumption can make the heart beat faster and harder. Alcohol may also produce dysrhythmias, which can lead to MI.

Smoking. Cigarette smoking increases BP and heart rate. These factors, coupled with the increased amount of carbon monoxide in the bloodstream, may cause chest pain.

Cocaine. Cocaine use increases heart rate, BP, and contractility of the left ventricle. This drug also causes coronary artery vasoconstriction, leading to chest pain. 

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Miscellaneous causes of chest pain

Syphilis. In later stages, syphilis can cause narrowing of the coronary arteries, leading to anginal-type chest pain. Syphilis can also cause aortic regurgitation and aortic aneurysms.

Severe anemia. A patient with severe anemia may experience chest pain, fatigue, palpitations, and shortness of breath on exertion.

Stress or panic attacks. These risk factors lead to hyperventilation and rapid heart rate, resulting in chest pain.

Thyroid disease. Hyperthyroid and hypothyroid states are potential causes of chest pain. In hyperthyroidism, the heart rate is elevated, even at rest, leading to chest pain. In patients with hypothyroidism, the heart rate will be very slow, and heart function will be impaired. This can cause pain during exertion.

Abnormal fluid retention. Many conditions and some medications (e.g., nonsteroidal anti-inflammatory drugs) cause fluid retention. This leads to increased pressure within the left ventricle, promoting chest pain.

Exercise. To prevent cramping, many parents warn their children to wait 30 minutes after eating before swimming. While the validity of this advice is debatable, exercising after eating can be a source of chest pain.

Deconditioning and weight gain. Patients who are out of shape or have recently gained weight may complain of chest pain.