Chest Pain-Somatic Chest Pain-Visceral Chest Pain-Referred Chest Pain

Chest Pain

The presenting symptom of chest pain is a common problem in clinical practice. Unfortunately, chest pain is a symptom common to many conditions and may be caused by disease in the thoracic and abdominal walls or in many different thoracic and abdominal viscera. The severity of the pain is often unrelated to the seriousness of the cause. Myocardial pain may mimic esophagitis, musculoskeletal chest wall pain, and other nonlife- threatening causes. Unless the physician is astute, a patient may be discharged with a more serious condition than the symptoms indicate. It is not good enough to have a correct diagnosis only 99% of the time with chest pain. An understanding of chest pain helps the physician in the systematic consideration of the differential diagnosis

Somatic Chest Pain

Pain arising from the chest or abdominal walls is intense and discretely localized. Somatic pain arises in sensory nerve endings in these structures and is conducted to the central nervous system by segmental spinal nerves.

Visceral Chest Pain

Visceral pain is diffuse and poorly localized. It is conducted to the central nervous system along afferent autonomic nerves. Most visceral pain fibers ascend to the spinal cord along sympathetic nerves and enter the cord through the posterior nerve roots of segmental spinal nerves. Some pain fibers from the pharynx and upper part of the esophagus and the trachea enter the central nervous system through the parasympathetic nerves via the glossopharyngeal and vagus nerves.

Referred Chest Pain

Referred chest pain is the feeling of pain at a location other than the site of origin of the stimulus, but in an area supplied by the same or adjacent segments of the spinal cord. Both somatic and visceral structures can produce referred pain.