Chest pain may be accompanied by other signs and symptoms like coughing. The pain may be due to forceful or persistent coughing, or can occur independently of the coughing. Nevertheless it is important to identify if both chest pain and coughing are related and to isolate the possible causes of both. Chest pain with coughing is not always due to respiratory causes since certain gastrointestinal and cardiac (heart) conditions can cause chest pain and also trigger coughing.

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Approach to Chest Pain

Upon presenting to your doctor with chest pain, a rational and step-by-step approach to diagnosing the cause of the pain will be followed. This will include a thorough case taking and physical examination which may be followed by tests and investigations to exclude or confirm differential diagnoses.

Case Taking and History

Assisting your doctor by providing pertinent information for a quick chest pain diagnosis will allow for the appropriate treatment to be administered as soon as possible.

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Stress chest pain is among the more disturbing symptoms that one will experience in life. The first thought is that of a heart attack and in high risk patients, this should always be a consideration. However in many cases of chest pain which is triggered or exacerbated by stress, a host of other physiological processes could account for the pain apart from the heart. Some of these may be related to serious pathologies while others are episodic and not as clinically significant.

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Nerve pain or neuralgia can occur for various reasons and may occur on its own or be accompanied by other signs and symptoms related to the cause. This type of pain does not always indicate nerve damage and may be due to injury, pressure, inflammation, chemical irritation or infection. When the cause of the pain is experienced at a site away from the point of injury or inflammation, then this is known as referred pain.

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The wall of the chest cavity is made up of many muscles which attach to the bones or ligaments of the chest. These muscles are not only responsible for movement of structures within the thorax (chest cavity) and may also play a part in head, neck, upper limb and abdominal movement. Any muscle chest pain that is aggravated by certain movements will assist your doctor in identifying which of these muscles may be injured. Ligaments and tendons may also be responsible for the pain.

Chest Muscles

The diaphragm is the flat muscle that lies at the bottom of the thoracic cavity. It separates the contents of the chest from that of the abdomen and is a major muscle of respiration. At times, muscle chest pain may only be noticed upon movement or breathing or persist even upon rest.

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The bones of the thoracic cavity are part of the outer chest wall with the sternum, clavicle and ribs in the front (anterior), ribs on the sides (lateral) and ribs and vertebrae at the back (posterior). The scapula may also be considered as part of the chest wall as any pathology within this bone may also cause bone chest pain.

Causes of Bone Chest Pain

Pain arising from the bones or joints may cause chest pain that will often elicit tenderness to touch or firm pressure. The pain usually aggravates with breathing or movement and may ease when at rest.

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The esophagus (food pipe) runs through the thoracic cavity and any disorder affecting this part of the gastrointestinal tract may cause chest pain. Apart from a portion of the stomach which can protrude into the thoracic cavity in the case of a hiatal hernia, the other main parts of the gatrointestinal tract are within the abdomen. However these associated organs and other sections of the GI tract located with the abdomen may cause referred pain to the chest.

Causes of  GI Chest Pain

It is important to note if the chest pain is emanating and isolated to the chest cavity itself or if there is pain present elsewhere in the body as well. This will aid with a diagnosis. Most cases of GI chest pain is not life threatening and should only be considered once the causes of lung chest pain or heart chest pain have been excluded.

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Causes of Heart Chest Pain

Cardiovascular conditions that result in chest pain should always be taken seriously as some of the causes are life threatening and require emergency medical attention. Heart chest pain may be severe and sudden with other signs and symptoms like dizziness, shortness of breath (dyspnea) and fainting spells. This should raise the warning flag to seek immediate medical attention.

At other times, chest pain due to heart conditions may not require urgent attention but without medical treatment at some point, these causes can complicate into life threatening situations. Some of the causes of chest pain may also cause breastbone pain as part of the heart lies behind this bone.

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Causes of Lung Chest Pain

The most common causes of pulmonary chest pain is a result of pathology within the lungs although conditions affecting the air passages may also cause chest pain. Lung chest pain may either be one side or affect both sides simultaneously and some of the common symptoms that occur along with the chest pain includes shortness of breath, abnormal breathing sounds and/or coughing.

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