“The Many Faces of Chest Pain: Exploring Different Types and their Implications”

Chest pain is a very common symptom that is associated with different medical conditions ranging from cardiac (heart) related causes to non- cardiac causes. Depending on the severity, location, onset, radiation, alleviating or exacerbating factors, chest pain can be narrowed down to different causes. Understanding the different presentation of chest pain will serve as a pointer to the cause of it.

In this article, using the acronym SOCRATES we would identify the characteristics of chest pain and how they relate to different causes

1. Site and Severity

It can be felt in any area in the chest wall. common areas include behind the sternum, left chest area, at the xiphoid process, just below the neck, at the back. Pain around the sternum could be associated with the heart, the oesophagus or the ribs. Pain in the left chest area might be due to a heart condition, trauma to the affected region, a tumor. a mild chest pain might just be angina but a severe one can be a heart attack.

2. Onset

It could either be sudden in onset or insidious in onset. Sudden onset could be due to trauma, heart attack, muscle strain, panic attack. Insidous chest pain could be caused by GIT problems like GERD, oesophagitis, pneumonia.

3. Character

Chest pain could be dull, squeezing, burning, sharp, stabbing etc. Burning sensation is usually seen in GERD, oesophagitis. Stabbing or squeezing pain in heart attack, sharp pain in angina.

4. Radiation

It can radiate to the back, shoulder, arm, neck etc. In heart attack it can radiate to the shoulder, arm. In GERD it can radiate to the back, when lying down it can spread to the upper chest wall and the neck.

5. Alleviating and exacerbating factors

Chest pain relieved by a change in position like lying at an angle of 30 degrees and worsened by lying flat on the head most likely has a cardiac origin. If it is relieve by drinking water or milk and worsened by spicy food , then it is most likely caused by GERD . If lying down opposite the affected side provides relief then it could be of a muscular damage origin. In the case of angina, it is worsened by exercise and relieved by rest.


From the criteria above, it makes it easier to identify the most likely cause of any chest pain. For example if it is located in the left chest area, dull, mild, worsened by exercise and relieved by rest it is probably angina. If it is behind the sternum, burning, worsened by spicy food and relieved with water or milk then it is probably GERD.

It is noteworthy that whatever the type may be , it is imperative you see a doctor because chest pain can be nothing or can be an indicator of a life threatening disease.

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