Chest pain is a common complaint that frequently brings patients into the emergency department, and for good reason; a significant proportion of chest pain is cardiac in origin (at least in the middle aged and older population). People who have certain risk factors for heart disease like high cholesterol, diabetes mellitus, tobacco use, peripheral vascular disease, male gender, and older age, are more likely to have a cardiac cause of chest pain, where as young healthy individuals are more likely to have a non-cardiac origin of chest pain (although it is important to note that heart problems and cardiac chest pain can and do occur in young individuals, but just less frequently). Non-cardiac causes of chest pain are diverse, but most musculoskeletal in nature. The most common musculoskeletal cause of chest pain is costochondritis, which is an inflammatory condition involving multiple joints between the ribs and sternum. Less common causes include sternalis syndrome (a condition characterized by pain in the body of the sternum), Xiphoidalgia (a condition characterized by pain and discomfort associated with movement or bending of the xiphoid process at the bottom of the sternum), Tietze's syndrome (a painful localized swelling of the joints between the upper ribs and sternum as well as the joint between the collar bone and sternum), and other rheumatic diseases like lupus, rheumatoid arthritis, and other spondyloarthropathies. Sometimes the symptoms of these problems can be very difficult to distinguish from cardiac chest pain, so very frequently other tests like an EKG or measurement of cardiac enzymes in the blood are required to prove that chest pain is not due to the heart.
Generally chest pain due to cardiac causes is not associated with any redness, swelling, or pain to the touch; so occasionally presence of these symptoms is sufficient to decrease the suspicion of cardiac chest pain. Cardiac chest pain is also typically associated with shortness of breath and is exacerbated by physical activity; which are characteristics atypical for musculoskeletal chest pain. The bottom line is that all chest pain requires a visit to a doctor
for a formal evaluation, regardless of how consistent it may or may not seem to be with cardiac chest pain.
The only reliable way to determine the cause of chest pain is complete evaluation by a doctor in person and potentially testing such as an EKG, stress test, or cardiac enzyme measurement. If you experience chest pain you should go to the emergency department immediately to be examined by a doctor. If you repeatedly have chest pain, you should see a primary care doctor
because more testing may be needed to determine the exact cause of the pain.