Chest Pain Causes 

Heart Attack Causes 

A heart attack  is caused  by coronary heart disease, or coronary artery disease. Heart disease may  be caused by cholesterol buildup in  the coronary arteries (atherosclerosis), blood clots, or spasm  of the vessels  that supply blood  to the heart. 

Risk factors for  a heart attack are: 

• high blood pressure 
• diabetes 
• smoking 
• high cholesterol 
• family history of heart attacks at ages younger than 60 years, one or more previous heart attacks, male gender 
• obesity 
• Postmenopausal women  are at higher risk than premenopausal women. This is thought to  be due to loss of  the protective effects of the hormone estrogen at menopause.  It was previously treated by hormone supplements (hormone replacement therapy, or HRT). However, research findings  have changed our thinking  on HRT; long-term HRT is no longer recommended for most women. 
• Use of cocaine  and similar stimulants. 

Angina Causes 

• Angina may be caused by spasm, narrowing, or partial blockage of an artery  that supplies blood  to the heart. 
• The most common cause is coronary heart disease,  in which  a blood clot or buildup  of fatty material inside  the blood vessel (atherosclerosis) reduces blood flow but does not completely block the blood vessel. 
• Angina  can be triggered by exercise or physical exertion, by emotional stress, or by certain heart rhythm disorders (arrhythmias) that cause the heart to beat very fast. 

Aortic Dissection Causes 

• Aortic dissection  may be caused by conditions that damage  the innermost lining  of the aorta. 
• These include uncontrolled high blood pressure, connective-tissue diseases, cocaine use, advanced age, pregnancy, congenital heart disease, and cardiac catheterization (a medical procedure).   Marfan's syndrome, a defect of mesenchymal tissue, is associated with dilatation of the ascending aorta and dissection.
• Men are at higher risk than women. 
• A similar condition is aortic aneurysm.  This is an enlargement of the aorta that  can rupture, causing pain and bleeding. Aneurysms  can occur in the aorta in the  chest or the abdomen. 

Pulmonary Embolism Causes 

Pulmonary embolism risk factors include: 

• sedentary lifestyle, 
• obesity,  
• prolonged immobility, 
• fracture  of a long bone  of the legs, 
• pregnancy,  
• cancer,  
• history or family history  of blood clots, 
• irregular heartbeat (arrhythmias), 
• heart attack, or 
• Congestive heart failure. 

Women who use birth control pills and smoke cigarettes are at higher risk than women who have only one or neither of  these risk factors (especially over the age of 35). 

Spontaneous Pneumothorax Causes 

Spontaneous pneumothorax (collapsed lung) occurs when the pressure balance between the sac that contains the lung  and the outside atmosphere is disrupted. 

• Injury to the  chest that pierces through to the lung sac is the most common cause of this condition. 
• This  can be caused by trauma, as in  a car wreck, bad fall, gunshot wound or stabbing, or  in surgery. 
• Some very thin and tall people may suffer a spontaneous pneumothorax due to stretched lung tissues and abnormal air sacs in  the upper portions  of their lungs. It is possible for these abnormal air sacs to rupture with even  a sneeze or excessive coughing. 
• Other risk factors for pneumothorax include AIDS-related pneumonia, emphysema, severe asthma, cystic fibrosis, cancer,  and marijuana and crack cocaine use 

Perforated Viscus Causes 

Perforated viscus  may be caused by direct  or indirect injury. Irritation  to the diaphragm in this case comes from below the chest. The diaphragm is the muscle that allows us to breathe. It is located up under the ribs and separates the  chest and abdominal cavity. Any irritation to the diaphragm, even from below it, can cause  pain to  be felt in the chest. 

Risk factors  not related to trauma are: 

• untreated ulcers, 
• prolonged or forceful vomiting, 
• swallowing  a foreign body, 
• cancer, 
• appendicitis, 
• long-term steroid use, 
• infection of the gallbladder, 
• gallstones,  and
• AIDS. 

Pericarditis Causes 
Pericarditis can be caused by viral infection, bacterial infection, cancer, connective-tissue diseases, certain medications, radiation treatment, and chronic renal failure. 

• One life-threatening complication of pericarditis  is cardiac tamponade. 
• Cardiac tamponade is an accumulation  of fluid around  the heart. This prevents the heart from effectively pumping blood  to the body. 
• Symptoms of cardiac tamponade include sudden onset of shortness of breath, fainting,  and chest pain.

Pneumonia Causes 

Pneumonia may be caused by viral, bacterial, or fungal infections of the lungs. 

Esophagus Related Causes 

Chest pain originating from the esophagus may have several causes. 

• Acid reflux (GERD) may  be caused by any factors  that decrease the pressure on the lower part  of the esophagus, decreased movement  of the esophagus,  or prolonged emptying  of the stomach. This condition may be brought on by: 

1. consumption  of high-fat foods, 
2. nicotine use, 
3. alcohol use, 
4. caffeine, pregnancy, 
5. certain medications (for example, nitrates, calcium channel blockers, anticholinergics, estrogen, progesterone), 
6. diabetes,  or
7. scleroderma. 

• Esophagitis may be caused by yeast, fungi, viruses, bacteria, or irritation from medications. 
• Esophageal spasm is caused by excessive, intensified, or uncoordinated contractions  of the smooth muscle  of the esophagus. Spasm may  be triggered by emotional upset or swallowing  very hot or cold liquids. 

Notes: Dr. M. Kristine Schlossberg

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EditText of this page (last edited February 9, 2010)