From the Guidelines
Yes, gallstones can sometimes manifest as chest pain, although this is not the most common symptom. Gallstone pain typically presents as upper right abdominal pain, but in some cases, it can radiate to the chest, particularly the right side or center of the chest. This chest pain may be mistaken for a heart attack, which is why it's crucial to seek medical attention for any unexplained chest pain. The mechanism behind this referred pain is related to the shared nerve pathways between the gallbladder and the chest area. When gallstones cause inflammation or obstruction in the gallbladder, the pain signals can be interpreted by the brain as coming from the chest region 1.
Some key points to consider:
- Gallstones are common, with an estimated 10% to 15% of the adult population in the United States having gallstones 1
- Common bile duct (CBD) stones are present in approximately 10% of those with gallstone disease 1
- Even in the absence of symptoms, choledocholithiasis requires intervention because of the risk of developing obstructive jaundice, cholangitis, acute pancreatitis, and potentially secondary biliary cirrhosis 1
- If you experience chest pain along with other symptoms like nausea, vomiting, or pain in the upper right abdomen, especially after eating fatty foods, it's essential to consult a healthcare provider. They may perform an ultrasound or other imaging tests to diagnose gallstones.
Treatment for gallstones causing chest pain would depend on the severity and frequency of symptoms. Options range from watchful waiting and dietary changes to medications like ursodeoxycholic acid or surgical removal of the gallbladder (cholecystectomy) in more severe cases. It's crucial to note that patients with CBDS should be offered stone extraction, assuming that they are fit enough to undergo treatment, as recommended by recent National Institute for Health and Care Excellence (NICE) guidelines 1.
From the Research
Gallstones and Thoracic Pain
- Cholelithiasis, or gallstones, can manifest as thoracic pain, although this is not the most common presentation 2.
- The typical symptoms of gallstone disease include episodic upper abdominal pain, often located in the epigastrium and/or the right upper quadrant, which may radiate to the upper back 3.
- However, some cases of gallstone disease can present with atypical symptoms, including thoracic pain, which can be mistaken for cardiac chest pain 2.
- The vagal cardiobiliary reflex can cause bradycardia and electrocardiographic changes in patients with acute cholecystitis, leading to a misdiagnosis of acute coronary syndrome 2.
Diagnosis and Treatment
- Diagnosis of gallstone disease is mainly based on clinical symptoms, abdominal ultrasonography, and liver biochemistry tests 4.
- Treatment of gallstone disease often involves surgical or endoscopic interventions, and current treatment algorithms remain predominantly invasive 4.
- In some cases, patients with gallstone disease may undergo invasive cardiac procedures due to a misdiagnosis of cardiac chest pain, highlighting the importance of considering gallstone disease in the differential diagnosis of thoracic pain 2.
Complications of Gallstone Disease
- Gallstone disease can lead to serious complications, including acute cholecystitis, acute cholangitis, and biliary pancreatitis 5, 6.
- These complications can range from simple recurrent biliary colic to severe, life-threatening conditions, and require prompt diagnosis and treatment 5, 6.
- The risk of complications from gallstone disease is higher in patients with symptomatic gallstones, and clinicians should be aware of the potential for atypical presentations, including thoracic pain 3, 2.