Chest pain risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Common underlying causes in the development of chest pain may be associated with the cardiac, respiratory, or gastrointestinal systems. Risk factors include smoking, obesity, drug abuse, [[GERD] and psychiatric disorders.

• Risk factors assessment is an important step in the evaluation of a patient presenting with chest pain for establishing the pretest risk. The CAD Consortium models assess age, sex, symptom, hospital setting, diabetes, hypertension, hyperlipidemia and smoking.^[1]
• Common risk factors in the development of chest pain may be occupational, environmental, genetic, and viral and include the following: ^[2][3][4][5]
  • Cardiac risk factors;
  • Advanced age
    • Previous history of myocardial infarction
    • History of valvular disorders
    • Pericarditis and myocarditis
    • Family history of cardiomyopathies
    • Hypertension
    • High blood lipids
    • Diabetes
    • Tobacco use
  • Pulmonary risk factors;
    • Prior history of pulmonary embolism or DVTs
    • Hormonal contraceptive use
    • Malignancies
    • Recent surgery
    • Immobilization
    • History of pneumonia
    • Trauma/pulmonary contusion
    • Pneumothorax or pleural effusion
  • Gastrointestinal Risk factors;
    • Obesity
    • Pregnancy
    • Hiatal hernia
    • Recent gastroesophageal procedures involving scopes
    • Boerhaave syndrome

• Less common risk factors in the development of [disease name] include: ^[6][7][8][9]
  • Physical inactivity
  • Drug abuse, eg cocaine
  • History of esophageal motility/hypersensitivity disorders
  • Psychological comorbidity
  • New exercise routine
  • Recent trauma
  • Viral infections
  • Sickle cell disease

Increased age is a risk factor not only for acute coronary syndromes but also for other alternative diagnoses that present with chest pain.^[1]

Patients with sickle cell disease may present with chest pain in patients without traditional risk factors for acute coronary syndrome and must be evaluated for acute myocardial infarction.^[1]

• Noncardiac causes of chest pain including gastrointestinal and psychological have negative effect on the quality of life.
• Gastrointestinal symptoms (heartburn, dysphagia, acid regurgitation) and psychological symtoms such as anxiety, depression, neuroticism should be consulted for noncardiac chest pain.^[8]