On physical examination, significant findings include: loud systolic murmur and palpable triple apical impulse due to palpable presystolic fourth heart sound. Aortic dissection is characterized by severe chest pain that radiates the back. It is usually associated with Marfans syndrome and hypertension. On examination, murmur of aortic insufficiency can be heard with unequal radial pulses. Pericarditis: This condition can be the result of viral infection such as coxsackie virus and echovirus, tuberculosis, autoimmune disease, uremia, and after myocardial infarction (Dressler syndrome). The chest pain is often pleuritic in nature (associated with respiration) which is aggravated when lying down and relieved on sitting forward, sometimes, accompanied by fever. On auscultation, pericardial friction rub can be heard. Cardiac tamponade
Arrhythmia: Atrial fibrillation and a number of other arrhythmias can cause chest pain. Myocarditis
Mitral valve prolapse syndrome: Those affected are usually slim females presented with chest pain which is sharp in quality, localized at the apex, and relieved when lying down. Other symptoms include: shortness of breath, fatigue, and palpitations. On auscultation, midsystolic click followed by late systolic murmur can be heard, louder when person is in standing position. Aortic aneurysm

Respiratory
Asthma is a common long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. Chest pain usually happens during a strenuous activity or heavy exercise.
Functional dyspepsia
Hiatus hernia
Jackhammer esophagus (hypercontractile peristalsis): Intense long-lasting esophageal muscle spasm. Acute cholecystitis: Characterized by positive Murphys sign where the person has a cessation of inhalation when the doctor places his finger at the right subcostal region of the abdomen. Acute pancreatitis: History of excessive alcohol use, cholelithiasis (stones in the gallbladder), and hypertriglyceridemia are risk factors for pancreatitis. It is a constant, boring pain in the upper abdomen. Perforated peptic ulcer: Sudden onset of severe pain in the upper abdomen which later develops into peritonitis (inflammation of tissues that lines the abdominal organs). Acute gastritis

Chest wall
Costochondritis or Tietzes syndrome: An inflammation of a costochondral junction. Any movements or palpation of the chest can reproduce the symptoms. Spinal nerve problem
Fibromyalgia
Chest wall problems
Radiculopathy
Precordial catch syndrome: Another benign and harmless form of a sharp, localized chest pain often mistaken for heart disease. Breast conditions
Herpes zoster (shingles): It is usually described as a burning sensation over the chest in a unilateral dermatome distribution. However, diagnosis can be difficult because the pain usually appears before the characteristic rash is visible. Tuberculosis
Osteoarthritis
Bornholm disease
Rib fracture

Psychological
Panic attack: Chest pain is a common symptom of panic attacks, with as high as 78% of persons describing chest pain with their worst panic attacks. Overall chest pain is a symptom of up to 48% of sudden-onset panic attacks, and 10% of gradual-onset panic attacks. Anxiety
Clinical depression
Somatization disorder
Hypochondria

Others
Hyperventilation syndrome often presents with chest pain and a tingling sensation of the fingertips and around the mouth.