Chest Wall Pain

Variable, often unclear

Often below the left breast or along the costal cartilages; also elsewhere

Stabbing, sticking, or dull, aching




Precordial, below the left breast, or across the anterior chest

Stabbing, sticking, or dull, aching


Note: Remember that chest pain may be referred from extrathoracic structures such as the neck (arthritis) and abdomen

(biliary colic, acute cholecystitis). Pleural pain may be due to abdominal conditions such

as subdiaphragmatic abscess.


Factors That Aggravate

Factors That Relieve

Associated Symptoms

Usually 1-3 min but up to Exertion, especially in the cold; meals; Rest, nitroglycerin 10 min. Prolonged episodes emotional stress. May occur at rest up to 20 min

Sometimes dyspnea, nausea, sweating

20 min to several hr



Breathing, changing position, coughing, lying down, sometimes swallowing

Abrupt onset, early peak, Hypertension persistent for hours or more

Nausea, vomiting, sweating, weakness

Sitting forward may relieve it. Of the underlying illness

Of the underlying illness

Syncope, hemiplegia, paraplegia

Variable Persistent


Breathing, coughing, movements of the trunk


Lying on the involved side may Of the underlying illness relieve it.

Variable Variable

Fleeting to hours or days Movement of chest, trunk, arms

Large meal; bending over, lying down Antacids, sometimes belching Sometimes regurgitation, dysphagia

Sometimes nitroglycerin Dysphagia

Swallowing of food or cold liquid; emotional stress

Often local tenderness

Fleeting to hours or day

May follow effort, emotional stress

Breathlessness, palpitations, weakness, anxiety

TABLE 6-2 ■ Dyspnea

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