Acute Chest Pain Worsened by Breathing or Movement

CLINICAL DIAGNOSTIC MANUAL

Acute chest pain that worsens with breathing or movement is a symptom that requires immediate evaluation due to its potential severity. This type of pain may indicate conditions affecting both cardiac and non-cardiac structures. The location, nature, and triggering factors of the pain are crucial in guiding the diagnosis.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Acute Myocardial Infarction	Intense, crushing chest pain that may radiate to the left arm, neck, jaw, or back. Often accompanied by sweating, nausea, and fatigue.	Chest pain with typical characteristics and presence of risk factors.	Elevated cardiac troponins and ECG changes.
Pericarditis	Sharp, stabbing pain in the centre of the chest that improves when leaning forward. May be accompanied by fever and signs of infection.	Acute chest pain that improves when leaning forward.	ECG showing diffuse ST elevation, echocardiogram.
Pulmonary Embolism	Sudden, sharp chest pain, especially when breathing deeply, accompanied by shortness of breath, sometimes haemoptysis.	Chest pain with dyspnoea and risk factors for thromboembolism.	Chest CT with angiography showing arterial thrombus.
Pneumothorax	Sudden, severe chest pain with decreased chest movement on the affected side, shortness of breath.	History of trauma or spontaneous onset with acute symptoms.	Chest X-ray showing lung collapse.
Pleuritis	Chest pain that worsens with breathing or coughing, often sharp and localised to the affected area.	Chest pain associated with respiratory movements.	Chest X-ray, sometimes chest ultrasound.
Chest Wall Dysfunction (Tietze’s Syndrome)	Localised chest pain often around the sternum, may be palpable as tender swelling.	Localised pain at costosternal joints with swelling.	Exclusion of other causes, response to anti-inflammatory treatment.