{
  "id": "chest-pain",
  "title": "Chest pain",
  "lang": "en",
  "source_lang": "en",
  "summary": "Chest pain is discomfort felt in the front of the thorax. It is a symptom with many possible causes, from life-threatening cardiac, vascular and pulmonary conditions to musculoskeletal and digestive ones.",
  "category": "health",
  "subcategory": "diseases",
  "type": "concept",
  "aliases": [
    "Thoracalgia",
    "chest discomfort"
  ],
  "generated_at": "2026-10-09",
  "model": "pro/claude-haiku-5-5",
  "url": "https://aiwiki.page/en/chest-pain/",
  "translations": {
    "zh-Hans": {
      "url": "https://aiwiki.page/zh/chest-pain/",
      "json": "https://aiwiki.page/zh/chest-pain.json"
    }
  },
  "sections": [
    {
      "heading": "",
      "text": "Chest pain is discomfort or pain felt in the front of the thorax. It is a symptom rather than a single disease, and it can originate in the heart, the great vessels, the lungs, the esophagus and stomach, the chest wall, or in psychological processes. Clinical evaluation therefore centres on sorting: identifying the relatively uncommon conditions that threaten life in the short term, and distinguishing them from the much larger number of benign causes."
    },
    {
      "heading": "Epidemiology",
      "text": "Chest pain is one of the most frequent reasons people seek emergency care. In the United States it is the second-most common reason for presenting to the emergency department, with more than 6.5 million annual ED visits and 4 million outpatient visits. Estimates for Europe and the United States together put the figure at about 15 million presentations in a single year, accounting for approximately 1 in 10 attendances and 4 in 10 unscheduled hospital admissions. Despite this volume, most people evaluated for chest pain are found not to have a heart-related cause, so the condition places a considerable diagnostic and resource burden on emergency services."
    },
    {
      "heading": "Causes",
      "text": "Causes are commonly grouped by organ system.\n\nCardiac. These include acute coronary syndromes, which cover myocardial infarction and unstable forms of angina, as well as stable coronary artery disease, pericarditis, and valve disease. Among valve disorders, chest pain may occur in the presence of valvular heart disease, particularly stenotic lesions of the aortic or mitral valve with secondary pulmonary hypertension. Acute pathology of the aorta is also a cardiac-region emergency: an aortic dissection can present as severe acute chest pain that may radiate to the back. See aortic-dissection.\n\nPulmonary and vascular. pulmonary-embolism is a key diagnosis to consider. Its pattern is often distinct: tachycardia and dyspnea occur in more than 90% of patients, and pain is often provoked by inspiration. Pneumonia may cause localized pleuritic chest pain accompanied by a friction rub. Pneumothorax may be accompanied by pleuritic chest pain and unilateral absence of breath sounds.\n\nGastrointestinal. Some digestive causes are serious. Chest pain accompanied by a painful, tympanic abdomen may indicate a potentially life-threatening gastrointestinal etiology such as esophageal rupture. More common examples include gastroesophageal reflux and biliary or peptic disease. Pain from abdominal organs can be felt in the chest, a phenomenon known as referred pain.\n\nMusculoskeletal and psychological. Of the noncardiac causes of acute chest pain, musculoskeletal causes are the most common, including costochondritis. Psychological causes, including anxiety disorders, also appear in the differential diagnosis for noncardiac chest pain."
    },
    {
      "heading": "Clinical assessment",
      "text": "History. Chest pain may be described as pressure, tightness, or discomfort, and it may be felt in the shoulders, arms, neck, back, upper abdomen, or jaw. It is considered acute when it has a new onset or a change in pattern, intensity, or duration, and stable when it is chronic with unchanging triggers such as exertion or emotional stress. Guidelines advise against the vague label \"atypical,\" because it is not helpful in determining the cause and can be misinterpreted as benign in nature. Instead, pain is classified as cardiac, possibly cardiac, or noncardiac. Some features shift the probability: fleeting chest pain lasting only a few seconds is unlikely to be related to ischemic heart disease. A sudden, tearing quality, particularly in a person with high blood pressure or a known bicuspid aortic valve or aortic dilation, is considered suspicious of an acute aortic syndrome.\n\nPhysical examination. The 2021 AHA/ACC guideline recommends that a focused cardiovascular examination be performed initially to aid in the diagnosis of ACS or other potentially serious causes of chest pain and to identify complications. Examination findings are often unhelpful in uncomplicated ACS, which may be normal in uncomplicated cases.\n\nElectrocardiography and biomarkers. The electrocardiogram (ECG) and cardiac troponin measurements form the diagnostic cornerstones of diagnosis and clinical work-up of any patient with suspected ACS. Cardiac troponins are the preferred markers for the diagnosis of myocardial injury. Because troponin rises with a delay, there is a known limitation: troponin is undetectable by current assays in peripheral blood within 3 to 4 hours after onset of chest pain in AMI, the so-called \"troponin-blind\" period. Research into biomarkers such as copeptin seeks to shorten this window. High-sensitivity troponin assays were designed for the diagnosis of acute coronary syndrome among patients presenting to the emergency department with chest pain. One observational study from Rome found that the use of hsTnI led to a significantly shorter time to diagnosis than conventional troponin I.\n\nImaging. Imaging selection depends on the suspected cause. Immediate echocardiography should be used in patients with suspected nonischemic causes of chest pain such as aortic dissection, pericardial effusion, and pulmonary embolism. Coronary CT angiography is not universally endorsed for this setting; one professional society advises against it in high-risk emergency patients with acute chest pain.\n\nRisk stratification. Older guidance describes a pathway in which most high-risk patients should be hospitalized, intermediate-risk patients should undergo a structured evaluation often in a chest pain unit, and many low-risk patients can be discharged with appropriate follow-up."
    },
    {
      "heading": "Guidelines and emergency care",
      "text": "The 2021 AHA/ACC guideline was developed for the evaluation of acute or stable chest pain in outpatient and emergency department settings, emphasizing the diagnosis of chest pain with an ischemic etiology. It states that initial evaluation should focus on ruling out life-threatening illnesses such as acute coronary syndrome, aortic dissection, and pulmonary embolism, which are often not indicated by pain severity. The guideline also calls for efforts to expedite the evaluation of patients with acute chest pain, including patient education to call emergency medical services for transport to the nearest emergency department."
    },
    {
      "heading": "Limitations and controversies",
      "text": "Several issues complicate chest pain assessment. First, the troponin-blind period limits early exclusion of myocardial infarction. Second, the sheer volume of visits contributes to overcrowding in the Emergency Department and is associated with worse outcomes for all patients in this setting. Third, assessment is subjective: conscious and unconscious biases with regard to sex, age, ethnicity, and/or cultural background can influence the classification of symptoms within the ischemic continuum. Fourth, admission rates can exceed diagnoses: in one UK protocol, less than 20% of those admitted to hospital on the suspicion of ACS actually have that diagnosis. Finally, the choice of biomarkers and imaging strategies continues to be debated, and guideline quality varies; one systematic review found a wide variety of quality in these documents."
    }
  ],
  "links": [
    "pain",
    "gastroesophageal-reflux-disease",
    "anxiety-disorders",
    "biomarker"
  ],
  "sources": [
    {
      "title": "Quality of undifferentiated chest pain evaluation and diagnosis guidelines: a systematic review and critical appraisal",
      "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772255/"
    },
    {
      "title": "Cardiac troponin at the point of care in acute and chronic coronary syndromes",
      "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400525/"
    },
    {
      "title": "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines",
      "url": "https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029"
    },
    {
      "title": "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines",
      "url": "https://www.jacc.org/doi/10.1016/j.jacc.2021.07.052"
    },
    {
      "title": "Chest Pain Evaluation: Updated Guidelines From the AHA/ACC",
      "url": "https://www.aafp.org/pubs/afp/issues/2023/0200/practice-guidelines-chest-pain-evaluation.html"
    },
    {
      "title": "Guideline for the Evaluation and Diagnosis of Chest Pain",
      "url": "https://cdn-corpweb.heartflow.com/assets/docs/ACC_AHA_Guidelines_ChestPain_PocketGuide_2021.pdf"
    },
    {
      "title": "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines - ScienceDirect",
      "url": "https://www.sciencedirect.com/science/article/pii/S0735109721057946"
    },
    {
      "title": "Troponin Testing in Acute Coronary Syndrome Diagnosis - European Society of Medicine",
      "url": "https://esmed.org/troponin-testing-in-acute-coronary-syndrome-diagnosis/"
    },
    {
      "title": "Diagnosis of Acute Coronary Syndrome",
      "url": "https://www.aafp.org/pubs/afp/issues/2005/0701/p119.html"
    },
    {
      "title": "Advantageous Predictors of Acute Coronary Syndromes Evaluation (APACE) Study",
      "url": "https://clinicaltrials.gov/study/NCT00470587"
    },
    {
      "title": "Diagnosis of myocardial injury vs ischemia (& related topics) - EMCrit Project",
      "url": "https://emcrit.org/ibcc/troponin/"
    },
    {
      "title": "Advantage of Using of High-Sensitivity Troponin I Compared to Conventional Troponin I in Shortening Time to Rule out/in Acute Coronary Syndrome in Chest Pain Patients Presenting to the Emergency Department",
      "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608198/"
    },
    {
      "title": "2021 AHA/ACC Chest Pain Guideline Perspectives - American College of Cardiology",
      "url": "https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2021/10/27/14/06/2021-Guideline-for-Chest-Pain-gl_chestpain"
    },
    {
      "title": "The 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain: An Interventionalist’s Viewpoint",
      "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11308083/"
    },
    {
      "title": "PRe-hospital Evaluation of Sensitive TrOponin (PRESTO) Study: multicentre prospective diagnostic accuracy study protocol",
      "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830682/"
    },
    {
      "title": "Acute Coronary Syndrome: Diagnostic Evaluation",
      "url": "https://www.aafp.org/pubs/afp/issues/2017/0201/p170.html"
    }
  ],
  "license": "https://creativecommons.org/licenses/by/4.0/"
}