Causes of chest pain:

A. Cardiac:

1. Myocardial ischaemia (angina).
2.  Myocardial infarction.
3. Myocardititis
4. Pericarditis. 5 Mitral valve prolapse.

B. Oesophageal :

1. Oesophagitis
2. Oesophageal spasm

C. Lungs/pleura:

1. Pulmonary embolism
2. Malignancy.
3. Bronchospasm
4. Pulmonary infarct
5. Pneumonia.
6. Tuberculosis
7. Pneumothorax.

D. Musculoskeletal:

1. Osteoarthritis.
2. Rib fracture/injury.
3. Intercostal muscle injury
4. Costrocondritis.
5. Epidemic myalgia.

E. Neurological:

1. Prolapse intervertebral disk.
2. Herpes zoster.
3. Thoracic outlet syndrome.

Features of angina chest pain:

Site: Centre of the chest

Mede of onset :  Builds up gradually in proportion to the intensity of exertion. 

Character:  Patient describes angina as a tightness or heaviness. The victim may complain discomfort rather than pain

Radiation: It may radiate to either or both arms, to the throat or jaw and less commonly to the back or epigastrium . 

Associated symptoms:  Angina is commonly accompanied by a feeling of breathlessness.

Timing/deration: Angina is a short-lived discomfort, usually lasting less than 5-10 minutes. 

Aggravating/exacerbating factors: It is precipitated by conditions which temporarily increase myocardial oxygen demand such as exertion, emotional excitement, cold weather, exercise after meal. 

Relieving factory: Rest or taking sublingual glyceryl-tri-nitrate (GTN).

Severity: It is usually not severe

Features of myocardial infarction/MI Chest Pain: 

Site: Centre of the chest.

Mode of onset:  Takes several minutes or even longer to develop.

Character: Dull, constricting, choking or heavy and is usually described as squeezing, crushing buming or aching 

Radiation: It may radiate to either or both arms, to the throat or jaw and less commonly to the back or epigastrium.

Associated symptoms:  Feeling of breathlessness, autonomic symptoms such as profuse sweat nausea, vomiting, palpitation, anxiety.

Timing/duration:  Persists for prolonged duration.

 Aggravating/exacerbating factors: It is precipitated by conditions which temporarily increase myocardial oxygen demand such as exertion, emotional excitement, cold weather, exercise after meal

Relieving factors: Not relieved by rest or taking sublingual glyceryl-tri-nitrate (GTN).

Severity:  It is usually severe and patient feels fear of death.

features of pericarditis Chest Pain:

Site: Retrosternal.

Radiation: Radiates to left shoulder and back.

Prodrome:  May be preceded by viral illness.

Onset: No obvious initial precipitating factor, tends to fluctuate in intensity.

Nature:  May be stabbing or raw-like sand paper. Often described as sharp, rarely as tight or heavy. 

Aggravating factor:  Changes in posture, respiration. 

 Relieving factor: Analgesics especially NSAIDS.

Associated feature: Pericardial rub.