CHEST WALL PAIN

Cervical Disk:
A cervical disk may irritate the nerve roots going to the chest wall and produce chronic chest pain that is aggravated by walking and certain body positions. The pain tends to be more superficial than that seen with obstructive coronary artery disease and is more likely to be present at rest.

Thoracic Outlet Syndrome:
The nerves and blood vessels that enter the arm often have to go through a bottleneck of muscles. If a blood vessel or a nerve is kinked by a muscle or a rib, arm and chest pain may develop that is associated with walking. Since exertional chest pain is a hallmark of coronary artery disease, it is easy to see why confusion may arise. The pain is induced by swinging of the arms, and can be reproduced by elevating the arm and rotating it.

Tietze's Syndrome:
Inflammation and swelling of the cartilage between the rib and breastbone (costochondral or chondrosternal joints is known as Tietze's syndrome. Such chest pain tends to be superficial rather than deep, is aggravated by breathing, and is very tender if the area is pressed.

Tenderness of the muscles of the chest wall:
A variety of factors may be responsible for tenderness of chest wall muscles including injury from direct trauma (usually several days before the onset of pain), coughing, and weight lifting causing a pulled muscle. Usually the chest pain is localized to a small area, is brief while it lasts, is aggravated by chest wall movements, turning, twisting and deep breathing, and may last many hours.

Herpes Zoster:
A severe skin rash that does not spread beyond the midline, may cause extreme chest pain in the pre-eruptive stage. Typically the skin is extremely sensitive over the involved area. Herpes may not be suspected until the skin eruption actually occurs.

Hyperventilation Syndrome:
An extremely common cause of chest pain is the hyperventilation syndrome. Hyperventilation is simply over breathing as a result of anxiety or fear. It also has been called panic attacks. Typically the subject unconsciously starts to breath more rapidly and deeply when under stress. The over breathing is often interspersed with deep sighs. In its acute form it will quickly produce a variety of symptoms including lightheadedness, dizziness, a far away feeling, numbness, palpitations, blurred visions, flushing, and tingling of the hands and around the mouth. Sometimes the victim will even faint. In its milder form, the subject may be constantly over breathing throughout the day. In so doing there is increased use of the chest muscles. If there is enough overuse of these muscles, they will become painful producing chest pain. Usually the victim is not consciously aware that he is over breathing, but rather feels short of breath. When this is associated with pounding of one's heart, dizziness, blurred vision and the other symptoms of hyperventilation, it is not hard to understand the panic that may accompany this disorder. Because the symptoms are due to over breathing and blowing off of carbon dioxide from the lungs, the chest pain and shortness of breath do not occur during exertion but rather at rest. Indeed, physical exertion, which will produce carbon dioxide, makes the victim feel better.

Primary Muscle Pain:
This includes some poorly understood disorders that have been called fibrositis, fibromyalgia, myalgia and neuralgia. The pain of these disorders tend to be chronic and ill-defined by the patient, are usually not related to exertion, and are confined to localized areas of the chest in locations that are different than what is seen with cardiac pain. The patient is usually more concerned about the significance of the symptoms, and whether it is a sign of heart disease rather than the intensity of the pain.

Cancer
may originate or spread to any structure in the chest including the heart and cause chest pain. Such pain tends to be continuous and not related to physical exertion. The diagnosis often may be made by a chest x-ray. Cancer also may spread to the spine and vertebrae with irritation of the nerve roots that go to the chest. Such pain may be quite severe and will not respond to the usual cardiac medications.

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