Causes systémiques ou originales de douleurs thoraciques

Takotsubo syndrome can rarely lead to 'broken heart' death. It is probably linked to spasms of coronary arteries induced by stress. Extensive akinesia of the heart apex has been demonstrated together with focal myocardial oedema on MRI and transient lower voltage of QRS on EKG. Several drugs like cocaine, high dose morphine, metamphetamine and cannabis can also induce coronary spasms, as well as some chemotherapies for cancer. Kounis syndrome, including de novo angina in young people together with various allergic features, can follow exposure to contrasts agents or other allergizing products. Right endocarditis leads to painful septic emboli in the lungs. Spontaneous dissections of coronary arteries rarely occur in post-partum, as well as isolated sub-clavian dissections in young women. Pain in basithoracic left flank worsened by exercise associated with transient haematuria is suggestive of nutcracker syndrome due to pinching of left renal vein between aorta and superior mesenteric artery. Hypercalcaemia and hypocalcaemia, carpal tunnel syndrome, and various disorders of dorsal back or spinal cord can also induce chest pain, as well as sternal infections and numerous costal tumours. Auto-inflammatory syndromes (mainly FMF and TRAPS), and various connectivitis and vasculitis can also foster thoracic pain: lupus, rheumatoid arthritis, rheumatoid vasculitis, granulomatous vasculitis, Kawasaki's disease, Behçet, sarcoidosis, polychondritis, IgG4 syndrome, hypereosinophilic syndromes, pulmonary fibrosis, as well as various types of porphyrias and Fabry's disease.