Chest Pain (Thoracic Pain)

The term thoracic pain – colloquially called chest pain – (synonyms: thoracic pain; chest pain; thoracic pain; thoracic pain syndrome; thoracalgia; thoracodynia; thoracic discomfort; uncharacteristic chest pain; ICD-10 R07.4: Chest pain, unspecified) refers to pain in the thoracic (chest) region. The pain occurs predominantly on the left side, but may also radiate to the opposite side of the thorax as well as into the left arm and/or down the left side of the neck to the jaw. Likewise, radiation to the abdomen and/or back is possible. Thoracic pain is one of the most common health symptoms and one of the regular occasions for consultation in a family doctor’s office. It can present as chronic or acute thoracic pain. Thoracic pain is often classified by cause:

  • Cardiac cause (8.5-16 (-30) %) – the cause is in the area of the heart.
  • Non-cardiac cause – lungs, esophagus (esophagus) and musculoskeletal system are mainly involved – the latter represents the most common cause of chest pain

Five causes of thoracic pain are described as “dramatic”:

  1. Acute coronary syndrome (AKS or. ACS, acute coronary syndrome; spectrum of cardiovascular disease ranging from unstable angina (iAP; UA; “chest tightness”/heart pain with inconsistent symptoms; 18%) to the two major forms of myocardial infarction (heart attack), non-ST elevation myocardial infarction (NSTEMI; 8%) and ST elevation myocardial infarction (STEMI; 8%)).
  2. Aortic dissection (synonym: aneurysm dissecans aortae; acute splitting (dissection) of the wall layers of the aorta (main artery)) or acute aortic syndrome (classic aortic dissection; intramural hematoma; penetrating atherosclerotic ulcer; symptomatic aortic aneurysm) (0.3%)
  3. Boerhaave syndrome (spontaneous esophageal rupture due to vomiting).
  4. Pulmonary embolism (pulmonary artery embolism; occlusion of a pulmonary artery by a thrombus (blood clot)) (2 %)
  5. Tension pneumothorax (so much air accumulates next to the lungs that a dangerous overpressure is created)

It is also known as the “big five” (the “big five”). In the primary care setting, the cause of chest pain is mostly musculoskeletal (about 49%). This is followed by cardiovascular (about 16%) and psychogenic (about 11%) disorders, as well as others. In emergency medical care, cardiovascular disorders are the main cause of chest pain, accounting for 60 %. Approximately 3-6% of all emergency patients present with the leading symptom of chest pain. Chest pain can be a symptom of many diseases (see under “Differential Diagnoses”). Sex ratio: Men and women are equally affected. Frequency peak: The symptom occurs predominantly in middle age, i.e. around 59 years (35-93 years, patients under 35 years were excluded). Note: Children also suffer from thoracic pain. For example, 6.1% of boys and 7.9% of girls aged 3-17 years reported having experienced chest pain. The prevalence (frequency of illness) is 0.7% (in Germany). Thoracic pain accounts for about 1.5% of all new physician-patient contacts in primary care (primary health care). Course and prognosis: Thoracic pain can be acute – in which case it is an emergency – or chronic. The decision for inpatient monitoring and further diagnostics depends on the presence of signs of a vital threat as well as the suspected diagnosis and possible available diagnostic procedures. As part of the further workup, if acute coronary syndrome (ACS) is suspected and confirmed, admission to an appropriate hospital with an attached chest pain unit (CPU) must be made. In this case, uninterrupted monitoring must be ensured on the way to the emergency room. The prognosis of chest pain depends on the underlying disease, being most favorable when the cause is musculoskeletal. Note: In patients discharged from a hospital with a diagnosis of “unexplained chest pain,” cardiovascular disease was detected in approximately 30% of patients on cardiac evaluation within 180 days of hospital discharge.Within one year, men in the under-65 age group were 53% more likely than the general population to die from cardiac and non-cardiac diseases as a result of cardiovascular disease. Among women in the same age group, the overall mortality rate was 45% higher, but death from cardiovascular disease was lower than expected (-23%).