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Disease Description (Causes and Symptoms)

• Definition: Chest pain is pain felt in the chest area. Depending on the cause, it can range widely from life-threatening diseases (such as myocardial infarction, aortic dissection, and pulmonary embolism) to musculoskeletal pain, gastroesophageal reflux disease, and panic attacks.
• Main causes (examples): Coronary artery disease (angina, acute myocardial infarction), aortic diseases (dissection and aneurysm), pulmonary causes (pneumothorax, pulmonary embolism, pneumonia), digestive system causes (esophageal spasm and reflux), costochondritis and musculoskeletal conditions, pericarditis, anxiety and panic disorder, mediastinal tumors, and others.
• Summary of pathophysiology: Depending on the cause, the mechanisms producing pain differ, including ischemia (reduced blood flow to the heart muscle), rupture or separation of a blood vessel (aortic dissection), mechanical compression (pneumothorax), and embolism (pulmonary embolism).
• Symptom characteristics (findings helpful for differential diagnosis):
  • Cardiac ischemic pain: Pain in the center of the chest, a feeling of pressure or squeezing; worsens with activity and may improve with rest or nitroglycerin.
  • Acute aortic dissection: Sudden, extremely severe, tearing pain radiating to the back or abdomen.
  • Pulmonary embolism: Sudden chest pain + shortness of breath, cough, and hemoptysis.
  • Pneumothorax: Pain on one side of the chest + shortness of breath, with changes in breath sounds on auscultation.
  • Digestive causes: Related to food and affected by posture or swallowing.
  • Musculoskeletal causes: Worsen with movement or breathing, with localized tenderness.
• Emergency symptoms (immediate emergency department evaluation needed): Pain that is very sudden and severe, altered consciousness, shortness of breath, fainting or severe dizziness, or a history of heart disease or a relevant family history.

Treatment Methods

• General principles: Because treatment for chest pain differs according to the cause, the presence of serious causes is first assessed through differential diagnosis (electrocardiography, chest X-ray, blood tests [cardiac enzymes, D-dimer, etc.], and imaging studies), followed by standard treatment for the specific cause.
• Treatment by emergency or severe cause (summary):
  • Acute coronary syndrome (myocardial infarction and unstable angina): Oxygen (if needed), initial administration of aspirin, antiplatelet agents and anticoagulants, thrombolysis or percutaneous coronary intervention (PCI), beta-blockers, ACE inhibitors, statins, and others.
  • Aortic dissection: Hemodynamic stabilization (controlling heart rate and blood pressure; beta-blockers, etc.), followed by urgent surgical treatment (surgery or stenting).
  • Pulmonary embolism: Anticoagulant therapy (heparin → oral anticoagulants/NOACs); thrombolysis or embolectomy in severe cases.
  • Pneumothorax: Observation (if small and asymptomatic), chest tube insertion, or thoracentesis (in cases of an enlarging pneumothorax or shortness of breath).
  • Pneumonia and acute bronchitis: Antibiotics (when bacterial), and symptomatic treatment.
  • Pericarditis: Nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine (steroids if needed).
  • Esophageal and digestive causes: Antacids, proton pump inhibitors, and dietary changes.
  • Musculoskeletal pain: Rest, analgesics (such as NSAIDs), and physical therapy.
  • Panic disorder: Psychotherapy (cognitive behavioral therapy), with anxiolytics or antidepressants if needed.
• Lifestyle management and prevention: Smoking cessation, regular exercise, management of blood pressure, diabetes, and lipids, weight control, and stress management.
• Precautions and risk of complications: Ignoring the cause may lead to fatal outcomes (myocardial infarction, aortic rupture, and pulmonary embolism). Delayed diagnosis and treatment can lead to a worse prognosis.

Checklist Before an Outpatient Visit (Including Recommended Items to Bring and Example Questions)

• Recommended items to bring: A list of all medications currently being taken (including doses and times), allergy information, past medical history and surgical records, copies of recent test results (electrocardiogram, blood tests, chest imaging, etc.), photographs taken when symptoms occur and a symptom diary (recording the time the pain began, its duration, and factors that worsen or relieve it), and family history information (such as cardiovascular disease).
• Symptom record checklist: Time of onset, location and character of the pain (squeezing, stabbing, pressure, etc.), intensity (0–10), whether it radiates (to the arm, neck, back, jaw, etc.), triggering circumstances (exercise, after meals, breathing, posture), accompanying symptoms (shortness of breath, nausea, sweating, fainting, hemoptysis), and previous similar symptoms and response to treatment.
• Information to explain to the doctor in advance during an outpatient visit (example questions):
  • "When did the pain begin, and how long does it last?"
  • "What is the nature of the pain (squeezing, stabbing, etc.), and where does it radiate?"
  • "Is it related to exercise, meals, or changes in posture?"
  • "Do you have any underlying conditions (hypertension, diabetes, or dyslipidemia) or a family history of heart disease?"

Examples of General Questions to Ask the Doctor

• What are the possible causes of this pain? What is the most suspected diagnosis?
• What emergency tests and treatment are needed now?
• What are the main side effects of the prescribed medications, and what precautions should be taken when taking them?
• What additional tests should be performed (electrocardiography, blood tests, CT, echocardiography, etc.), and why are they needed?
• What should be changed in terms of lifestyle (exercise, diet, and medication)?

Examples of Condition-Specific Questions

• If a cardiac cause is suspected: "How can we distinguish whether this pain is due to cardiac ischemia (angina/myocardial infarction)? Can it be determined immediately through an electrocardiogram and cardiac enzyme tests?"
• If aortic dissection or pulmonary embolism is suspected: "When there is sudden, extremely severe pain or shortness of breath, which symptoms and test results indicate the need for emergency surgery or thrombolysis?"

(Note: Because chest pain can have many different causes, if symptoms are sudden and severe or are accompanied by shortness of breath, altered consciousness, or other such symptoms, an emergency medical facility should be visited immediately.)