Constipation-Related Chest Pain

Introduction to Constipation-Related Chest Pain

• The American College of Cardiology suggests that severe constipation can cause chest pain, though this is an uncommon presentation that requires careful evaluation to exclude life-threatening cardiac and other serious causes first, with gastrointestinal disorders accounting for approximately 10-20% of chest pain cases 1, 2.

Diagnostic Approach

• The American Heart Association recommends that before attributing chest pain to constipation, one must systematically exclude life-threatening causes, including cardiac causes such as acute coronary syndrome, which requires ECG and cardiac biomarkers, pulmonary embolism, aortic dissection, and esophageal rupture 1, 3, 4, 5.
• The American College of Cardiology states that evaluation for gastrointestinal causes is reasonable in patients with recurrent acute chest pain without evidence of cardiac or pulmonary causes, with a Class IIa recommendation 1, 2, 6.

Red Flags for Alternative Diagnosis

• The American Heart Association suggests that sudden onset of severe "ripping" pain suggests aortic dissection, pain with inspiration and lying supine suggests pericarditis, and diaphoresis, tachycardia, hypotension suggest acute coronary syndrome 3, 4, 5.

Management

• The American College of Cardiology recommends performing a focused cardiovascular examination, obtaining ECG and cardiac biomarkers if any concern for ACS, and assessing for signs of PE, aortic dissection, or esophageal rupture 3, 4.
• The American Heart Association suggests evaluating for constipation with a detailed history of bowel habits, straining, and incomplete evacuation, abdominal examination for distention and tenderness, and digital rectal examination to assess for fecal impaction, followed by initiation of aggressive laxative therapy with combination agents 1, 2, 7.