Table 3

Summary of causes and types of chest pain

AetiologyType of painSight of painRadiationDuration of painAssociated symptomsMode of onsetECG findingsRisk factors
AnginaVisceralRetrosternalNeck, jaw, shoulder, and arm>15 minNausea and dyspnoeaVariableST elevation or depression
PericarditisSomaticMidlineNeck, back, or shoulderHours to daysPain worse on movement or breathingVariableST elevation in all leads except aVR and V1Viral infection, recent MI trauma, post-cardiac surgery
Dissecting aortic aneurysmVisceral severeRetrosternalInterscapularVariableNausea and breathlessnessSuddenNon-specificHistory of hypertension
Cervical nerve root painSharp or aching, superficialUpper chest— possibly one sidedNeckVariableMay be exacerbated by neck movementVariableNone
Chest wall painSharp or achingLocalisedNoneVariableNoneVariableNone
Pulmonary embolismPleuriticUsually lateral aspect of chest wallNoneVariableBreathlessness, unilateral swollen legSuddenNon-specific S-T changes, tachycardiaRecent trauma or surgery, venous stasis or hypercoagulability
InfectionPleuritic or somaticUsually lateral aspect of chest wallNoneVariableBreathlessness, bronchi, bronchial breathingVariableNoneURTI, cough, sputum, fever
PneumothoraxPleuriticUsually lateral aspect of chest wallNeck and backVariableBreathlessnessSuddenNoneCOPD, trauma, tall, thin, young people
Oesophageal painAching or burningRetrosternalInterscapularMinutes to hoursDifficulty or pain on swallowingVariableNoneGastro-oesophageal reflux disease