What Causes Chest Pain? Why Do I Have Chest Pain?

Dr. Jaudy explains the causes of chest pain.

Many things can lead to chest pain, such as problems in the musculoskeletal system, problems in the cardiovascular and lymphatic systems, problems in the pulmonary system, problems in the digestive system, problems in the nervous system, and more. In this article, I will discuss these causes and others.

There are many, many causes of chest pain. Let’s briefly discuss many of the more common causes*. The following causes are examples of what can cause chest pain, not necessarily what is causing your chest pain. Without a thorough examination, it is difficult (or impossible) to determine the exact cause. You should always consult with your doctor about your chest pain or any other symptom you may be experiencing.

1. Problems in the musculoskeletal system

The chest region contains numerous muscles, bones, ligaments, and cartilage, including the ribs. The ribs move (articulation) due to the costochondral joints, which are joints between the ribs and the costal cartilage. There are also joints called costovertabral joints, which are between the ribs and the vertebrae. Inflammation of these joints can lead to chest pain (costochondritis or costovertabral chondritis), including joint or costal arthritis.

Broken or bruised ribs can cause chest pain, as can any inflammation or damage to the muscles of the chest can cause chest pain. Also, if the chest muscles are unable to get oxygen efficiently, it can cause a condition known as angina (angina pectoris).

2. Problems in the cardiovascular and lymphatic systems

Problems in the heart or the cardiovascular system can lead to chest pain. These include (but are not limited to):

Coronary artery disease (CAD)
Myocardial infarction (heart attack)
Myocarditis (inflammation of heart muscles)
Pericarditis (inflammation of the fibrous sac around the heart (pericardium))
Tachycardia
Calcification of blood vessels in or around the heart
Ventricular hypertrophy or hypertrophic cardiomyopathy (thickening of muscles or ventricle walls of the heart)
Decrease of oxygenated or oxygen-rich blood to the heart
Mitral valve prolapse (heart valves fail to close properly)
Coronary artery dissection, and any other type of heart problem.

Also, problems in the vascular system and lymphatic system of the chest can lead to chest pain. This includes problems in the aorta, such as aortic dissection and problems with lymphatic drainage.

3. Problems in the pulmonary (respiratory) system

Numerous problems in the lungs and respiratory system can lead to chest pain, including (but not limited to):

Pulmonary edema (fluid accumulation in the lungs)
Pleuritis (inflammation of the lining surrounding the lungs)
Decreased ability to breathe (such as due to chronic obstructive pulmonary disease, including asthma and emphysema)
Decreased rib excursion (ability of the ribs to open and close)
Pulmonary embolism (blood clot in the lungs),
Pneumonia or lung abscess
Pneumothorax (collapsing of the lung),
Venous congestion (filling of the veins and decreased circulation in the lungs)
Pulmonary hypertension
Impairment of gas exchange in the lungs, and other types of respiratory problems.

4. Problems in the digestive system, including the esophagus

Various problems in the gastrointestinal tract can cause chest pain, including (but not limited to):

Esophagitis (inflammation of the esophagus),
Gastroesophageal reflux disorder (GERD or acid reflux)
Esophageal motility disorders
Esophageal hypersensitivity
Esophageal rupture or perforation
Barrett’s esophagus
Peptic ulcers
Hiatal hernia
Irritable bowel syndrome (IBS)
Pancreatitis (inflammation of the pancreas)
Gall bladder problems including gall stones
Gastritis (inflammation of the stomach), and other gastrointestinal problems.

5. Problems in the nervous system

Nerves in the chest, such as the thoracic nerves, may become inflamed, leading to chest pain. Dysautonomia (dysfunction of the autonomic nervous system) can lead to various conditions that can cause chest pain. In addition, many of the conditions listed above are due to aberrant neural signaling between the brain and various organs and systems, such as hypersensitivity of the esophagus, pulmonary hypertension, tachycardia, and others.

6. Other problems that can cause chest pain

There are many other problems that can cause chest pain including shingles, anxiety or panic disorders, visceral referred pain (pain from organs may be sent to muscles, such as the muscles in the chest), and more.

Just from this list (and this is an incomplete list), you can see that chest pain is a very complex symptom with numerous possible causes. When you visit a doctor, it is important that you understand the complexity of chest pain and it is important that the doctor performs extensive, comprehensive testing to determine exactly what is causing your chest pain.

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