Chest pain is a common clinical problem with several possible causes.
Not all chest pain is due to a heart condition. The history and physical
examination often provide useful information for making the diagnosis.
In many patients with chest pain, no abnormalities are found. These
patients may display evidence of psychoneurosis (psychogenic chest pain or
Da Costa syndrome). In these patients, there is often a recent history of
heart disease in the family. Some of them on the other hand, who have
genuine heart disease develop an anxiety state and complain frequently of
chest pain. This is referred to as cardiac neurosis. Patients presumed to have
psychogenic chest pain need to be referred to a psychiatrist only after a
physical cause has been excluded and reassurance fails to relieve symptoms.
CAUSES
Originating from the heart:
· Ischaemic heart disease (stable angina pectoris, acute coronary
syndrome)
· Acute pericarditis
Originating from the lungs and pleura:
· Pneumonia with pleurisy
· Pleural effusion or empyema
· Pulmonary embolism
· Pneumothorax
· Tumour (lung cancer)
Originating from the oesophagus:
· Reflux oesophagitis
· Hiatus hernia
· Tumours
Originating from the aorta:
· Aortic dissection
Originating from the chest wall
· Intercostal myalgia
· Costochondritis
Originating from a psychoneurosis
· Psychogenic chest pain (Da Costa Syndrome)
· Cardiac neurosis
