Chest pain

Chest pain
Other names	Pectoralgia, stethalgia, thoracalgia, thoracodynia
Potential location of pain from a heart attack
Specialty	Emergency medicine, internal medicine, cardiology
Symptoms	Discomfort in the front of the chest[1]
Types	Cardiac, noncardiac[2]
Causes	Serious: Acute coronary syndrome (including heart attacks), pulmonary embolism, pneumothorax, pericarditis, aortic dissection, esophageal rupture[3] Common: Gastroesophageal reflux disease, psychological problems such as anxiety disorders, depression, stress etc, muscle or skeletal pain, pneumonia, shingles[3]
Diagnostic method	Medical history, physical exam, medical tests[3]
Treatment	Based on the underlying cause[1]
Medication	Aspirin, nitroglycerin[1][4]
Prognosis	Depends on the underlying cause[3]
Frequency	~5% of ER visits[3]

Chest pain is pain or discomfort in the chest, typically the front of the chest.^[1] It may be described as sharp, dull, pressure, heaviness or squeezing.^[3] Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath.^[1][3] It can be divided into heart-related and non-heart-related pain.^[1][2] Pain due to insufficient blood flow to the heart is also called angina pectoris.^[5] Those with diabetes or the elderly may have less clear symptoms.^[3]

Serious and relatively common causes include acute coronary syndrome such as a heart attack (31%), pulmonary embolism (2%), pneumothorax, pericarditis (4%), aortic dissection (1%) and esophageal rupture.^[3] Other common causes include gastroesophageal reflux disease (30%), muscle or skeletal pain (28%), pneumonia (2%), shingles (0.5%), pleuritis, traumatic and anxiety disorders.^[3][6] Determining the cause of chest pain is based on a person's medical history, a physical exam and other medical tests.^[3] About 3% of heart attacks, however, are initially missed.^[1]

Management of chest pain is based on the underlying cause.^[1] Initial treatment often includes the medications aspirin and nitroglycerin.^[1][4] The response to treatment does not usually indicate whether the pain is heart-related.^[1] When the cause is unclear, the person may be referred for further evaluation.^[3]

Chest pain represents about 5% of presenting problems to the emergency room.^[3] In the United States, about 8 million people go to the emergency department with chest pain a year.^[1] Of these, about 60% are admitted to either the hospital or an observation unit.^[1] The cost of emergency visits for chest pain in the United States is more than US$8 billion per year.^[6] Chest pain accounts for about 0.5% of visits by children to the emergency department.^[7]