Chronic Chest Pain Types Chronic chest pain may not only be life-threatening, but physically, psychologically

and economically debilitating. Many patients have undergone extensive testing, monitoring and treatment, including surgeries, angiograms and even psychiatric care without relief. Mayo treats chest pain patients who fit within two profiles:
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people with chest pain, but who have no significant coronary artery disease people with obstructive coronary artery disease who have undergone multiple invasive procedures and are no longer candidates for conventional revascularization such as stents or bypass surgery.

Mayo is one of few medical centers in the world using a true multidisciplinary approach to diagnose and treat chronic chest pain. The Mayo Chest Pain Clinic is a last resort for patients with undiagnosed, misdiagnosed or unresolved conditions, including:
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Angina Anxiety or panic attacks Aortic dissection Asthma and other respiratory conditions Atypical chest pain Coronary artery spasm Endothelial dysfunction Gastrointestinal disorders Mitral valve prolapse Pericarditis Prinzmetals Syndrome or Graybiel's Syndrome Refactory angina Sensitive heart Syndrome X or microvascular angina

Angina Angina is one of the most common symptoms of heart disease. It results from the heart not getting enough blood or oxygen. Pain intensity varies from person-to-person. Chest pain may be typical or atypical. Typical chest pain is felt under the sternum or chest bone and is characterized by a heavy or squeezing feeling often caused by exertion or emotions. Angina is usually experienced as discomfort or tightness, or pressure in the chest or in the back, neck, jaw, shoulders and arms (especially the left arm). Anxiety or Panic Attacks Anxiety or panic attacks are characterized by surges of intense anxiety and fear that occur without warning and with no apparent reason. Panic attacks may be accompanied by sharp

. Benign chest wall pain can be diagnosed with a thorough patient history and exam. and the pain tends to be less severe and abrupt. Read more about treatment of aortic dissection. With gradual aortic dissection. Asthma and Other Respiratory Conditions Many respiratory conditions can cause chest pain. Atypical chest pain's causes include overexertion. shoulder. back or arm. which supplies blood to the heart. will generally reveal respiratory-related sources of chest pain. anxiety and panic attacks can significantly disrupt an individual's life. severe "tearing" pain beneath the sternum or chest bone. Benign Chest Wall Pain Benign chest wall pain is a common. It tends to be sudden. An examination by a doctor. the heart temporarily does not get enough oxygen and the patient experiences chest pain. This lining is very sensitive to irritation. but then goes away. including asthma. and often occurs at rest. the main artery from the heart. abrupt and sharp pain that interrupts breathing. temporary irritation of the membrane that lines and protects the lungs. Atypical Chest Pain Atypical chest pain is experienced outside the chest bone. As a result. Most people with benign chest wall pain experience an unexpected. Diagnosis involves a medical history and physical exam. Severe coughing can strain chest muscles.and abrupt chest pain. pneumonia and inflammation. This condition can lead to heart attack or stroke. Testing includes an ECG. Coronary Artery Spasm This type of chest pain is caused by ischemia (oxygen starvation) of the cardiac muscle. tearing of the aorta occurs more gradually. constant or increasing with exhaling or inhaling. abdomen. acid indigestion and headaches. throat. The chest wall may feel sore for hours or days after a panic attack. and mild or severe. sharp and short-lived. MRI and CT scan or cardiac catheterization. most likely caused by muscle contractions in the chest wall. Coronary artery spasm can occur anytime. bronchitis. People with lower thresholds for pain are more likely to complain of atypical chest pain and are likely to have greater anxiety and depression. including questions about the patient's medical history. Coronary spasm is a sudden and temporary narrowing or tightening of a small part of the coronary artery. Though easily treated with medication and relaxation techniques. The causes vary and may originate in the left chest. the diagnosis is made by ECG test. but often quite concerning to patients. Chest pain caused by lung problems can be concentrated or diffuse. Aortic dissection Aortic dissection is a tearing of the lining of the aorta. spasms. Sudden aortic dissection may be accompanied by sudden. and often a stress test or cardiac catheterization. When dissection is suspected. It is harmless and unrelated to exercise. leaving them achy for days.

Medications. The pain patients describe is often a "catching" discomfort. lying.Endothelial Dysfunction Coronary endothelial dysfunction is a disorder in the arteries that supply blood to the heart. Bloating from gas. standing. The endothelium is a thin layer of cells that lines blood vessels and regulates blood flow. Endothelial dysfunction is a key early sign of coronary artery disease. Alcohol. but in some cases. a physical exam. there is coronary artery obstruction.e. Pain from pericarditis can be intense and frightening. reflux or heartburn can also produce chest pain. bending). spasms may occur near the narrowing of the artery. management of the disease can relieve symptoms and improve the patient's quality of life. caffeine and spicy foods may contribute to these symptoms. Ulcers can cause a burning or gnawing pain near the stomach that extends up to chest. Patients often experience increased pain during breathing. In others chest pain is triggered by exertion. Treatments range from lifestyle changes to medication to surgery. In addition to a physical exam and history.. chest pain may occur at rest. Prinzmetals Syndrome or Graybiel's Syndrome Prinzmetals Syndrome or Graybiel's Syndrome is chest pain caused by spasms of coronary arteries. or prolapse. Mitral Valve Prolapse With mitral valve prolapse (MVP). esophagitis. Refractory Angina Refractory angina is characterized by symptoms of chest pain caused by coronary blockage due to advanced coronary disease in which the symptoms are not controlled by medication. may be perceived by patients as a form of chest pain. Read more about mitral valve disease. With Prinzmetals Syndrome. This flopping. and may even cause contraction. stents or surgery are . the patient may need to undergo an endoscopic procedure (examining the GI tract with a scope). the thin sac that surrounds and protects the heart. blood tests and an ECG. Some patients experience palpitations. Pericarditis Pericarditis is inflammation of the pericardium. angioplasty or bypass surgery. Symptoms such as chest pain result. In patients with endothelial dysfunction. ultrasound or a barium X-ray. Gastrointestinal Disorders A variety of gastrointestinal disorders can produce chest pain. Diagnosis of pericarditis is usually made through a medical history. abnormalities of the mitral valve cause it to flop back into the left atrium as the left ventricle contracts. and usually is confined to the chest area. The physician can diagnose an MVP with a stethoscope exam or an ECG test. In cases where there is obstruction. In most patients. smoking. Refractory angina cannot be cured. a stimulus that would normally cause vessels to expand and increase blood flow fails to do so. and often relates to their position (i.

Once treated. the patient's free nerve endings in the chest (nociceptors) are abnormally sensitive and cause a genuine perception of pain. Sensitive Heart Syndrome Sensitive heart syndrome describes the perception of ongoing generalized chest pain. even without any clinical evidence of coronary blockage or gastrointestinal disorders. such as PET scanning or MRI. Syndrome X or Microvascular Angina Syndrome X is characterized by chest pain without evidence of blockage in the large coronary arteries. . may help with the diagnosis in the future. the patient's prognosis is excellent and severe complications such as arrhythmias. The prognosis is generally excellent. Syndrome X may be caused by the small blood vessels in the heart inadequately dilating.treatment options. but symptoms can be debilitating. Sensitive heart syndrome is the subject of ongoing medical research. In this syndrome. Today. however. syndrome X is usually a diagnosis of exclusion — meaning that the patient may be diagnosed with this condition after tests do not identify any other causes of the chest pain. Because this condition is a small-vessel disease. heart attack or sudden death are rare. Medications commonly used to treat heart conditions may help relieve pain caused by Syndrome X. Special imaging tests. it can't be seen on an angiogram (an X-ray with dye that identifies blockages in blood vessels).