The pain starts suddenly, does not subside easily, aggravates and often causes patient taken to a emergency polyclinic. Can be accompanied by fever, sweating, paleness, cyanosis, tachycardia, and respiratory distress. Can be related or unrelated to the heart.

A- Causes Related to Heart

• Pericarditis: The pain is substernal and felt as if the heart is squeezed. The patient is more comfortable when sitting and states that the pain increases when lying down for examination. Temperature can be a little high or higher.
• Arrhythmia: The patient could complain about tachycardia, irregular heartbeat and dizziness. Arrhythmia is detected at examination and its type is identified by ECG.

B- Causes Other Than Heart

• Pulmonary Causes: Wandering pains on either side of the chest could appear during pneumonia, bronchitis and asthma. Pulmonary Hypertension (higher pulmonary artery pressure than normal) is another cause.
• Gastric Causes:The pain is usually in the center and even substernal. The cause is often acid reflux. It appears or becomes evident when lying down, and is reduced with antacids.

Can take for weeks and months. It is sometimes subsided, and disappears. Then it can recur after a while and relatively lasts shorter.

A. Psychological

In general, stress is present prior to pain. May occur at any time of the day. Not related to effort. The patient points at exactly over the heart when h/she is asked the location of the pain. Examination does not release anything and all tests are normal.

B. Causes Related to Heart

1. Cardiac Dilatation,
2. Pericarditis,
3. Mitral valve prolapse (loosened valves) Can cause chest pain, arrhythmia and tachycardia.
4. In children and teens between the ages of 8 and 16, strong, stinging, sudden pain that is sometimes intense enough to make one cry and increased as breathing, and lasts 1-2 minutes.
5. Congenital or acquired heart diseases

C. Chest Wall Pain

1. Costochondritis
2. Accompanied by pain without swelling of joints of ribs 2 and 5.
3. Tietze’s Syndrome
4. Painful inflammation accompanied by swollen joints of ribs 2 and 3.
5. Breast Tissue Pain
6. Growing breasts can be painful in teen girls and boys.
7. Chest Wall Deformations
8. Concavity or protrusion of chest wall, curved vertebral column can also cause chest pain.
9. Non-Noxious Teen Chest Pain