What are the most common etiologies of chest pain in adults?

From the Guidelines

The most common etiologies of chest pain in adults are musculoskeletal, cardiac, gastrointestinal, and pulmonary issues, with the specific cause varying depending on the clinical setting, as seen in a study published in the Journal of the American College of Cardiology in 2021 1.

Common Causes of Chest Pain

The causes of chest pain can be broadly categorized into several groups, including:

• Cardiovascular conditions, such as coronary artery disease, pericarditis, aortic dissection, and mitral valve prolapse
• Gastrointestinal issues, including gastroesophageal reflux disease (GERD), esophageal spasm, peptic ulcer disease, and gallbladder inflammation
• Musculoskeletal problems, such as costochondritis, muscle strain, or rib fractures
• Respiratory disorders, including pneumonia, pleurisy, pulmonary embolism, and pneumothorax
• Psychiatric causes, such as anxiety and panic attacks

Clinical Setting and Etiology

The underlying cause of chest pain varies depending on the clinical setting, with cardiac causes being more common in emergency departments and musculoskeletal causes being more common in general practice settings, as noted in a study published in the European Heart Journal in 2002 1.

Diagnostic Approach

A comprehensive history and physical examination are essential in evaluating chest pain, with the character of pain providing diagnostic clues, such as cardiac pain feeling like pressure or squeezing and radiating to the arm or jaw, as discussed in a guideline published in the Journal of the American College of Cardiology in 2021 1.

Importance of Immediate Medical Attention

Any unexplained chest pain, especially if accompanied by shortness of breath, nausea, sweating, or radiating pain, warrants immediate medical attention to rule out life-threatening conditions, as emphasized in a study published in Circulation in 2021 1.

From the Research

Common Etiologies of Chest Pain

The most common etiologies of chest pain in adults can be categorized into cardiac and noncardiac causes.

• Cardiac causes include:
  • Acute coronary syndrome (ACS) 2, 3, 4, 5
  • Angina pectoris, which can be stable or unstable 3
  • Acute myocardial infarction 3
• Noncardiac causes include:
  • Gastroesophageal disorders, such as gastroesophageal reflux disease (GERD) 3
  • Pulmonary causes, such as:
    • Acute pleurisy 6
    • Acute pulmonary embolism 6, 5
    • Pneumonia 6
    • Primary spontaneous pneumothorax 6
    • Pulmonary hypertension 6
    • Lung cancer 6
    • Mesothelioma 6
    • Acute exacerbation of chronic obstructive pulmonary disease (COPD) 6

Diagnosis and Assessment

Diagnosing the cause of chest pain requires a structured clinical assessment, including patient history-taking, physical examination, and clinical investigations 4.

• Healthcare practitioners should have knowledge of the causes and pathophysiology of chest pain, as well as the use of structured assessment tools and evidence-based guidelines 4.
• Initial evaluation of chest pain in the emergency department (ED) should focus on identifying life-threatening conditions, such as ACS, aortic dissection, and pulmonary embolism 5.