Table 3

Summary of causes and types of chest pain

Aetiology	Type of pain	Sight of pain	Radiation	Duration of pain	Associated symptoms	Mode of onset	ECG findings	Risk factors
Angina	Visceral	Retrosternal	Neck, jaw, shoulder, and arm	>15 min	Nausea and dyspnoea	Variable	ST elevation or depression
Pericarditis	Somatic	Midline	Neck, back, or shoulder	Hours to days	Pain worse on movement or breathing	Variable	ST elevation in all leads except aVR and V1	Viral infection, recent MI trauma, post-cardiac surgery
Dissecting aortic aneurysm	Visceral severe	Retrosternal	Interscapular	Variable	Nausea and breathlessness	Sudden	Non-specific	History of hypertension
Cervical nerve root pain	Sharp or aching, superficial	Upper chest— possibly one sided	Neck	Variable	May be exacerbated by neck movement	Variable	None
Chest wall pain	Sharp or aching	Localised	None	Variable	None	Variable	None
Pulmonary embolism	Pleuritic	Usually lateral aspect of chest wall	None	Variable	Breathlessness, unilateral swollen leg	Sudden	Non-specific S-T changes, tachycardia	Recent trauma or surgery, venous stasis or hypercoagulability
Infection	Pleuritic or somatic	Usually lateral aspect of chest wall	None	Variable	Breathlessness, bronchi, bronchial breathing	Variable	None	URTI, cough, sputum, fever
Pneumothorax	Pleuritic	Usually lateral aspect of chest wall	Neck and back	Variable	Breathlessness	Sudden	None	COPD, trauma, tall, thin, young people
Oesophageal pain	Aching or burning	Retrosternal	Interscapular	Minutes to hours	Difficulty or pain on swallowing	Variable	None	Gastro-oesophageal reflux disease